I am looking for some help on how I would CPT code this surgery. I do not do these often and could really use some direction.
Thanks in advance for any help!
OPERATION: Nasoendoscopy with septal turbinoplasty with therapeutic outfracture of the inferior turbinate. Concha bullosa reduction bilateral, bilateral sinuplasty, sinusectomy of frontal maxillary and sphenoid sinuses, bilateral anterior ethmoidectomy and bilateral propel placement.
OPERATIVE PROCEDURE: With the patient under general anesthesia, after prepping and draping in the usual way, we proceeded to inspection under fiberoptic nasal endoscopy. We note a deviated septum towards the left side and hypertrophic rhinitis grade 4 with important septal turbinal contact, and hypertrophy also of the middle turbinate. After infiltration of the septum inferior and middle turbinate with Xylocaine 1% with epinephrine we proceed with a hemitransfixion incision at the left side. We dissected the septum and removed the very deviated part of it. We replaced the other part at the midline. We closed the hemitransfixion incision with multiple stitches of chromic 3-0. We did some septal-septal stitches transfixion with chromic 3-0. After that, we proceed to reduction of the inferior turbinate with intramural reduction with the radiofrequency. Then we did a therapeutic outfracture of the inferior turbinate bilaterally and already we obtain very good opening of the nasal cavities. Then we proceed also to reduction of the middle turbinate. After that me medialize the left turbinate exposing the middle meatus and we proceed to an exploration of the left nasal frontal recess. There is inflammatory tissue so we make a debridement and we put in place also the balloon sinuplasty. After a good localization we inflate the balloon and we make a dilation and debridement lavage of this area. We repeated the same technique on the other side. After that we localize the ostium of the left maxillary sinus and we put the balloon sinuplasty in place. We inflate the balloon. We did debridement lavage of the maxillary sinus in the infundibulum and we repeat the same technique on the right side. Finally we make exploration of the left maxillary sinus and after localization we inflate the balloon. We make debridement and lavage. We repeated the same technique on the right side. After that we proceeded anterior ethmoidectomy bilaterally. We have some inflammatory tissue inside it. Then we put in place a propel device in each middle meatus in the ethmoid cavity. We put after that a piece of Xerogel in each middle meatus and we make a packing of the nose with dissolvable Gelfoam. The patient tolerated very well the operation and left the Operating Room in good condition.
Thanks in advance for any help!
OPERATION: Nasoendoscopy with septal turbinoplasty with therapeutic outfracture of the inferior turbinate. Concha bullosa reduction bilateral, bilateral sinuplasty, sinusectomy of frontal maxillary and sphenoid sinuses, bilateral anterior ethmoidectomy and bilateral propel placement.
OPERATIVE PROCEDURE: With the patient under general anesthesia, after prepping and draping in the usual way, we proceeded to inspection under fiberoptic nasal endoscopy. We note a deviated septum towards the left side and hypertrophic rhinitis grade 4 with important septal turbinal contact, and hypertrophy also of the middle turbinate. After infiltration of the septum inferior and middle turbinate with Xylocaine 1% with epinephrine we proceed with a hemitransfixion incision at the left side. We dissected the septum and removed the very deviated part of it. We replaced the other part at the midline. We closed the hemitransfixion incision with multiple stitches of chromic 3-0. We did some septal-septal stitches transfixion with chromic 3-0. After that, we proceed to reduction of the inferior turbinate with intramural reduction with the radiofrequency. Then we did a therapeutic outfracture of the inferior turbinate bilaterally and already we obtain very good opening of the nasal cavities. Then we proceed also to reduction of the middle turbinate. After that me medialize the left turbinate exposing the middle meatus and we proceed to an exploration of the left nasal frontal recess. There is inflammatory tissue so we make a debridement and we put in place also the balloon sinuplasty. After a good localization we inflate the balloon and we make a dilation and debridement lavage of this area. We repeated the same technique on the other side. After that we localize the ostium of the left maxillary sinus and we put the balloon sinuplasty in place. We inflate the balloon. We did debridement lavage of the maxillary sinus in the infundibulum and we repeat the same technique on the right side. Finally we make exploration of the left maxillary sinus and after localization we inflate the balloon. We make debridement and lavage. We repeated the same technique on the right side. After that we proceeded anterior ethmoidectomy bilaterally. We have some inflammatory tissue inside it. Then we put in place a propel device in each middle meatus in the ethmoid cavity. We put after that a piece of Xerogel in each middle meatus and we make a packing of the nose with dissolvable Gelfoam. The patient tolerated very well the operation and left the Operating Room in good condition.