Jaslene08
Guest
Im having difficulty when billing Latera, I believe it should be billed w an unlisted code 30699. However, can this be billed separately from the Septoplasty procedure? please find example report attached. HELP!
Procedure Performed: Septoplasty,septum perforation repair Bilateral nasal valve repair
Bilateral submucousal turbinoplasty,Adenoidectomy
Description of Procedure(s):
The patient was transported to the operating room and placed on the operating
table in the supine position. After general anesthesia with endotracheal
intubation, 4% cocaine pledgets were used in the nose for hemostasis and
local anesthesia. . 1% Lidocaine was injected into the bilateral columellar
areas and bilateral septal mucosa. Then the nose was examined, and noted a deviated septum to the right side
causing right obstruction. The deviation spur is touching the right inferior
turbinate. A #15 blade was used to make a hemitransfixion incision at the right side
since the deviation is mainly on the right side. After that, submucosal
mucoperichondrial dissection was carried down through the incision to separate
the mucopericondrium and the septal cartilage. Dissection was continued
posteriorly and superiorly and inferiorly, elevating the mucoperichondrium
from the septal bone as well. After that, a vertical incision was made with
a Dee knife anteriorly about 1 cm posterior to the caudal border of the septum
to leave a strut. Then the mucoperichondrial and mucoperiosteal dissection
were carried out on the left side as well.
The septal cartilage and bone was totally separated with its covering mucosa.
Then the deviation was identified, which was to the right side posterior and
then the swivel knife was used to remove the cartilage deviation and Takahashi
forceps were used to remove the posterior and superior bony deviation.
Maxillary crest deviation was removed with an osteotome.
Septum perforation repair: Because of the severe septum deviation, mucosa of
the septum are fragile. Through and through perforation was found during
surgery. After careful dissection of septum mucosa with the attached bone, a
pocket was made. A 2x3 septum patch was inserted between septum and remaining
cartilage. The removed nasal septum cartilage was inserted to overlap the
perforated area. 3-0 chromic suture was used to secure the patch.
Both nasal airways were very patent and then the 4-0 chromic mattress sutures
were used to close the septum. 4-0 chromic suture was used to suture the
incision on the right side and two Doyle splints were inserted into the nose
to keep the septum in place and both were covered by antibiotic ointment. The
nylon suture was used to suture the anterior end of the splint together.
Between the skin and the stitch, a small 2x2 gauze was padded. The surgery was
finished.
Bilateral INFERIOR TURBINOPLASTY
1% Lidocaine was injected into inferior turbinate. Cudle knife was used to
make a cut at the anterior end of the turbinates. A tunnel was made between
bone and mucosa. Olympus Cauterized Shaver was inserted and partially removed
the submucosal soft tissue and bone. Wound was cauterized. There is visible
decrease in size of the turbinate.
Adenoidectomy: a mouth gag was placed to expose the oral cavity, and a red
Robinson was inserted from the nose to mouth to hold the soft palate. The
palate was palpated, and there is no submucosal cleft palate. The suction
Bovie at a setting of 15 was used to cauterize the enlarged adenoid. After
the adenoid was cauterized, complete hemostasis was achieved, and the surgery
was finished. The mouth gag was removed, and the red Robinson was removed.
Latera Implant
After clean the nasal dorsum and nostril with betadine, suction was used to
identify the side of nasal valve collapse. Skin marker was marked on the
skin for insertion and end point. Double crown hook was used to expose the
nostril. Implant device was entered from the marked point and point toward
septum. After 3-4 mm, needle was pointed to superior marker. Lateral
implants were pushed in and the device was removed without difficult. Steril
strip was applied to the dorsum of the nose.
Procedure Performed: Septoplasty,septum perforation repair Bilateral nasal valve repair
Bilateral submucousal turbinoplasty,Adenoidectomy
Description of Procedure(s):
The patient was transported to the operating room and placed on the operating
table in the supine position. After general anesthesia with endotracheal
intubation, 4% cocaine pledgets were used in the nose for hemostasis and
local anesthesia. . 1% Lidocaine was injected into the bilateral columellar
areas and bilateral septal mucosa. Then the nose was examined, and noted a deviated septum to the right side
causing right obstruction. The deviation spur is touching the right inferior
turbinate. A #15 blade was used to make a hemitransfixion incision at the right side
since the deviation is mainly on the right side. After that, submucosal
mucoperichondrial dissection was carried down through the incision to separate
the mucopericondrium and the septal cartilage. Dissection was continued
posteriorly and superiorly and inferiorly, elevating the mucoperichondrium
from the septal bone as well. After that, a vertical incision was made with
a Dee knife anteriorly about 1 cm posterior to the caudal border of the septum
to leave a strut. Then the mucoperichondrial and mucoperiosteal dissection
were carried out on the left side as well.
The septal cartilage and bone was totally separated with its covering mucosa.
Then the deviation was identified, which was to the right side posterior and
then the swivel knife was used to remove the cartilage deviation and Takahashi
forceps were used to remove the posterior and superior bony deviation.
Maxillary crest deviation was removed with an osteotome.
Septum perforation repair: Because of the severe septum deviation, mucosa of
the septum are fragile. Through and through perforation was found during
surgery. After careful dissection of septum mucosa with the attached bone, a
pocket was made. A 2x3 septum patch was inserted between septum and remaining
cartilage. The removed nasal septum cartilage was inserted to overlap the
perforated area. 3-0 chromic suture was used to secure the patch.
Both nasal airways were very patent and then the 4-0 chromic mattress sutures
were used to close the septum. 4-0 chromic suture was used to suture the
incision on the right side and two Doyle splints were inserted into the nose
to keep the septum in place and both were covered by antibiotic ointment. The
nylon suture was used to suture the anterior end of the splint together.
Between the skin and the stitch, a small 2x2 gauze was padded. The surgery was
finished.
Bilateral INFERIOR TURBINOPLASTY
1% Lidocaine was injected into inferior turbinate. Cudle knife was used to
make a cut at the anterior end of the turbinates. A tunnel was made between
bone and mucosa. Olympus Cauterized Shaver was inserted and partially removed
the submucosal soft tissue and bone. Wound was cauterized. There is visible
decrease in size of the turbinate.
Adenoidectomy: a mouth gag was placed to expose the oral cavity, and a red
Robinson was inserted from the nose to mouth to hold the soft palate. The
palate was palpated, and there is no submucosal cleft palate. The suction
Bovie at a setting of 15 was used to cauterize the enlarged adenoid. After
the adenoid was cauterized, complete hemostasis was achieved, and the surgery
was finished. The mouth gag was removed, and the red Robinson was removed.
Latera Implant
After clean the nasal dorsum and nostril with betadine, suction was used to
identify the side of nasal valve collapse. Skin marker was marked on the
skin for insertion and end point. Double crown hook was used to expose the
nostril. Implant device was entered from the marked point and point toward
septum. After 3-4 mm, needle was pointed to superior marker. Lateral
implants were pushed in and the device was removed without difficult. Steril
strip was applied to the dorsum of the nose.