ehoelscher
New
Can both 30630 and 30520-51 be billed in the below scenario? I am on the fence since AlloDerm was used vs an autograft.
DETAILS OF OPERATION: The patient was taken to the operating room and placed under general endotracheal anesthesia. Nose was draped in standard fashion. A timeout was performed. Nose was packed with Afrin pledgets. Nasal septum infiltrated with local anesthetic. A left hemitransfixion incision was made. This was carefully dissected on the left hand side around the perforation, dissected also along the right hand side along the perforation. This was eventually taken to the bony septum of the vomerine bone. This was dissected to its entire length. This was markedly deviated. This was removed with Jansen-Middleton bone forceps. I then dissected the bony spur on the floor of the nose bilaterally from around the perforation. This was removed with sharp dissection with a Cottle elevator and then it was removed with an osteotome. This resulted in good midline nasal septum and the perforation itself was still intact, mucosa intact. At this point in time, I feel the best treatment would be to place an AlloDerm. The perforation was measured as well as the area around it to allow adequate cuff for placement of AlloDerm. A piece of AlloDerm was then marked and cut with scissors. The packing was removed. This was dipped in saline. It was softened a little bit, was then placed in the pocket and interrupted 4-0 chromic sutures were placed around through the mucosa and through the mucosa leaves and through the cuff of the AlloDerm to secure it in place. This resulted in a good repair. Next splints were secured to the nasal dorsum with 3-0 Prolene suture. The procedure was terminated. Nose was packed with NasoPore. The patient was awakened, extubated, and taken to PACU in stable condition.
DETAILS OF OPERATION: The patient was taken to the operating room and placed under general endotracheal anesthesia. Nose was draped in standard fashion. A timeout was performed. Nose was packed with Afrin pledgets. Nasal septum infiltrated with local anesthetic. A left hemitransfixion incision was made. This was carefully dissected on the left hand side around the perforation, dissected also along the right hand side along the perforation. This was eventually taken to the bony septum of the vomerine bone. This was dissected to its entire length. This was markedly deviated. This was removed with Jansen-Middleton bone forceps. I then dissected the bony spur on the floor of the nose bilaterally from around the perforation. This was removed with sharp dissection with a Cottle elevator and then it was removed with an osteotome. This resulted in good midline nasal septum and the perforation itself was still intact, mucosa intact. At this point in time, I feel the best treatment would be to place an AlloDerm. The perforation was measured as well as the area around it to allow adequate cuff for placement of AlloDerm. A piece of AlloDerm was then marked and cut with scissors. The packing was removed. This was dipped in saline. It was softened a little bit, was then placed in the pocket and interrupted 4-0 chromic sutures were placed around through the mucosa and through the mucosa leaves and through the cuff of the AlloDerm to secure it in place. This resulted in a good repair. Next splints were secured to the nasal dorsum with 3-0 Prolene suture. The procedure was terminated. Nose was packed with NasoPore. The patient was awakened, extubated, and taken to PACU in stable condition.