The Doctor asked us to billed the cpt does below, but the research I've done for a Skull base reconstruction, would 31255, 31288 (now 31259) & 30520 be included into 62165-62? for cpt 61619, the research I've found shows that code shouldn't even be billed so I know to keep that out. can you lead me to where I can find information that describes this surgery or what is documented for this surgery? Thank you! any help would be appreciated
the nasal cavities were evaluated with 0 degree scope.
the posterior nasal cavity and nasopharynx were without obvious masses.
1% lidocaine with 1:100,000 epinephrine was injected into the septum and middle turbinates on both sides.
the septum was noted to be deviated mostly to the left.
using a needle tip bovie, the septal flap to be harvested was demarcated on the right side.
the nasopharyngeal cuts were made just below the sphenoid ostium and the inferior edge of the nasopharynx in
horizontal fashion.
these cuts were then extended along the floor and superiorly to the mid septum just past the middle turbinate.
the mucoperichondrial and periosteal flaps were elevated using a sharp freer elevator.
the flap was then carefully dissected off of the nasopharynx and preserved for use later.
the right and left middle turbinates were then resected with curved scissors, inferior 1/2.
this was stored in saline for possible use at the end.
hemostasis was controlled with bovie cautery.
bilateral anterior and posterior ethmoidectomy was performed as there were disease within the sinus.
there was no infection noted
the bulla was opened and anterior ethmoid air cells opened.
then, the basal lamella was opened and posterior ethmoidectomy performed.
the cartilaginous septum was then incised and the posterior cartilaginous septum and bony septum was removed.
the bony septum was was removed with open rongeur.
the mid portion of the sphenoid face was drilled with a cutting burr, 4 mm.
the sphenoid ostia were identified on both sides and enlarged using the burr.
the two sides of the sphenoid sinus were connected.
the sinus septums were carefully drilled with diamond burr.
the sphenoid floor was also opened for access using the diamond burr.
the image guidance system was used throughout the case.
then, (other Dr.) performed the pituitary tumor resection.
we provided endoscopic access and guidance during the resection.
once (Other Dr.) was done with his part, we came back to reconstruct the skull base.
fat harvested was placed into the sphenoid cavity to obliterate the cavity.
the right septal flap was then straightened out. the flap was noted to be more than adequate to reconstruct the skull base
defect.
the flap was carefully laid over the sphenoid sinus cavity over the fat graft and to reconstruct the skull base.
the left septal flap was used to cover the posterior nasal floor.
duragen was sprayed over the flap.
PosiSep packing was placed over the flap to provide stability and packing.
regular propel was placed in the nasopharynx for extra support.
the patient was turned to anesthesia and extubated without complications.
the patient was transferred to recovery in stable condition.
all counts were correct at the end.
Findings
ethmoid and sphenoid without infection
septum deviated mostly to the left
- 30520 – septoplasty
- 31255 – ethmoidectomy
- 31288 – sphenoidotomy
- 62165-62 – Skull base reconstruction
- 61782 – scope
- 61619 – csf repair
the nasal cavities were evaluated with 0 degree scope.
the posterior nasal cavity and nasopharynx were without obvious masses.
1% lidocaine with 1:100,000 epinephrine was injected into the septum and middle turbinates on both sides.
the septum was noted to be deviated mostly to the left.
using a needle tip bovie, the septal flap to be harvested was demarcated on the right side.
the nasopharyngeal cuts were made just below the sphenoid ostium and the inferior edge of the nasopharynx in
horizontal fashion.
these cuts were then extended along the floor and superiorly to the mid septum just past the middle turbinate.
the mucoperichondrial and periosteal flaps were elevated using a sharp freer elevator.
the flap was then carefully dissected off of the nasopharynx and preserved for use later.
the right and left middle turbinates were then resected with curved scissors, inferior 1/2.
this was stored in saline for possible use at the end.
hemostasis was controlled with bovie cautery.
bilateral anterior and posterior ethmoidectomy was performed as there were disease within the sinus.
there was no infection noted
the bulla was opened and anterior ethmoid air cells opened.
then, the basal lamella was opened and posterior ethmoidectomy performed.
the cartilaginous septum was then incised and the posterior cartilaginous septum and bony septum was removed.
the bony septum was was removed with open rongeur.
the mid portion of the sphenoid face was drilled with a cutting burr, 4 mm.
the sphenoid ostia were identified on both sides and enlarged using the burr.
the two sides of the sphenoid sinus were connected.
the sinus septums were carefully drilled with diamond burr.
the sphenoid floor was also opened for access using the diamond burr.
the image guidance system was used throughout the case.
then, (other Dr.) performed the pituitary tumor resection.
we provided endoscopic access and guidance during the resection.
once (Other Dr.) was done with his part, we came back to reconstruct the skull base.
fat harvested was placed into the sphenoid cavity to obliterate the cavity.
the right septal flap was then straightened out. the flap was noted to be more than adequate to reconstruct the skull base
defect.
the flap was carefully laid over the sphenoid sinus cavity over the fat graft and to reconstruct the skull base.
the left septal flap was used to cover the posterior nasal floor.
duragen was sprayed over the flap.
PosiSep packing was placed over the flap to provide stability and packing.
regular propel was placed in the nasopharynx for extra support.
the patient was turned to anesthesia and extubated without complications.
the patient was transferred to recovery in stable condition.
all counts were correct at the end.
Findings
ethmoid and sphenoid without infection
septum deviated mostly to the left