Help needed, I am new enough to surgery coding that I need some guidance. The below case was coded with 14060, 20912, 20926 and 41870. I am probably wrong but aren't 20912 and 20926 for harvesting the bone graft. An allograft was used and then palatal skin graft and repair 41870. Would love another set of eyes and your opinions. Thank you in advance!!!!
attention was first drawn to the
left lip commissure region where a 45-degree Z-plasty was performed using a
#15 blade. The areas were undermined with a 15 blade and a tenotomy, and a
small Burow triangle was removed from the lip region. The area was closed
with Vicryl sutures deep and nylon sutures on the skin. Attention was then
drawn to the left ala, where a 15 blade was used to make an alar incision
at the alar-philtral groove. This area was lifted to expose the fat but
not entering into the nasal cavity. The fat was then debulked, and a
pocket was created up to the tip defining points of the nasal tip. At this
point, the allogeneic rib cartilage was shaped and fit to this region.
This was secured with a 4-0 nylon suture. A Weir-style incision was made
at the base of the left ala to help shape and move the nasal ala laterally.
Prior to finishing suturing fixation, patency was determined to be widened
and better than initial presentation. Nasal speculum evaluated the inside
of the nose and noted there were no tears. The skin was then closed with
Vicryl sutures deep and nylon sutures on the skin. Attention was then
drawn to the intraoral resection over tooth #11 where the gingival
recession was released with a 12B blade and a half-thickness mucoperiosteal
flap was elevated. This was connected into a Z-plasty incision over a scar
band. The Z-plasty was secured, and a full-thickness palatal graft of the
left maxilla was taken and sutured after deepithelializing the lateral
portions underneath the Z-plasty portion of the mucosal flaps. This was
secured with 5-0 chromic gut sutures. The entire area was copiously
irrigated and closed. Hemostasis was controlled. Cold pack was placed on
the left maxilla. Bacitracin was placed on the incision lines, and the
patient was turned over to the anesthesia team, who extubated the patient.
There were no complications with the case.
*
attention was first drawn to the
left lip commissure region where a 45-degree Z-plasty was performed using a
#15 blade. The areas were undermined with a 15 blade and a tenotomy, and a
small Burow triangle was removed from the lip region. The area was closed
with Vicryl sutures deep and nylon sutures on the skin. Attention was then
drawn to the left ala, where a 15 blade was used to make an alar incision
at the alar-philtral groove. This area was lifted to expose the fat but
not entering into the nasal cavity. The fat was then debulked, and a
pocket was created up to the tip defining points of the nasal tip. At this
point, the allogeneic rib cartilage was shaped and fit to this region.
This was secured with a 4-0 nylon suture. A Weir-style incision was made
at the base of the left ala to help shape and move the nasal ala laterally.
Prior to finishing suturing fixation, patency was determined to be widened
and better than initial presentation. Nasal speculum evaluated the inside
of the nose and noted there were no tears. The skin was then closed with
Vicryl sutures deep and nylon sutures on the skin. Attention was then
drawn to the intraoral resection over tooth #11 where the gingival
recession was released with a 12B blade and a half-thickness mucoperiosteal
flap was elevated. This was connected into a Z-plasty incision over a scar
band. The Z-plasty was secured, and a full-thickness palatal graft of the
left maxilla was taken and sutured after deepithelializing the lateral
portions underneath the Z-plasty portion of the mucosal flaps. This was
secured with 5-0 chromic gut sutures. The entire area was copiously
irrigated and closed. Hemostasis was controlled. Cold pack was placed on
the left maxilla. Bacitracin was placed on the incision lines, and the
patient was turned over to the anesthesia team, who extubated the patient.
There were no complications with the case.
*