SLELISON
Guest
Would this be coded with just 41899 or is there a code someone would recommend for the frenectomy and prosthesis removal (20670?)?
PREOPERATIVE DIAGNOSIS: Dental caries, acute situational anxiety, and cleft palate.
POSTOPERATIVE DIAGNOSIS: Dental caries, acute situational anxiety, and cleft palate.
PROCEDURE PERFORMED: Maxillary frenectomy, dental restorations, and prosthesis removal.
DESCRIPTION OF THE PROCEDURE: The patient was brought to the operating room. The patient was intubated using nasal intubation. A throat pack was placed and one dental x-ray was exposed revealing normal periapical findings in all areas except the maxillary cleft area. It was noted that an obturator prosthesis was in place. This was placed by the Cleft Team when the patient was an infant. They requested that this prosthesis be removed one month prior to soft tissue closure surgery. It was also noted that teeth # E and F had the beginnings of dental caries. There was a heavy maxillary labial frenulum also notable. Using Chlorhexidine gluconate 0.12% strength, the prosthesis was removed and the tissues adjacent to the tissues. This was done via a 2 x 2 gauze. A maxillary frenectomy was done using the diode laser. The protective eyewear was worn. This was used to remove hyperplastic and inflamed frenal tissues and enable improvement of oral hygiene. Teeth E and F had mesial disking done.
PREOPERATIVE DIAGNOSIS: Dental caries, acute situational anxiety, and cleft palate.
POSTOPERATIVE DIAGNOSIS: Dental caries, acute situational anxiety, and cleft palate.
PROCEDURE PERFORMED: Maxillary frenectomy, dental restorations, and prosthesis removal.
DESCRIPTION OF THE PROCEDURE: The patient was brought to the operating room. The patient was intubated using nasal intubation. A throat pack was placed and one dental x-ray was exposed revealing normal periapical findings in all areas except the maxillary cleft area. It was noted that an obturator prosthesis was in place. This was placed by the Cleft Team when the patient was an infant. They requested that this prosthesis be removed one month prior to soft tissue closure surgery. It was also noted that teeth # E and F had the beginnings of dental caries. There was a heavy maxillary labial frenulum also notable. Using Chlorhexidine gluconate 0.12% strength, the prosthesis was removed and the tissues adjacent to the tissues. This was done via a 2 x 2 gauze. A maxillary frenectomy was done using the diode laser. The protective eyewear was worn. This was used to remove hyperplastic and inflamed frenal tissues and enable improvement of oral hygiene. Teeth E and F had mesial disking done.
Last edited: