Hi All...Can anyone please help with this? The physician wants to code 30520/30140-50/30620. I'm not seeing 30140-50 and I don't agree with 30620. I currently have 30520 and C9771. Any thoughts or suggestions appreciated!! TIA
The patient was placed supine on the operating room table and general endotracheal anesthesia induced without difficulty. The head of the table was elevated 30 degrees above horizontal. The patient was draped with sterile linens. The nose was vasoconstricted with 4% cocaine on cottonoid pledgets and the nose was infiltrated with lidocaine 1% with 1:100,000 epinephrine. A time-out was called to confirm patient identity, site and type of procedure and any special circumstances. The pledgets were then removed and the nasal hairs trimmed. A throat pack was placed. A hemitransfixion incision was then made on the left side and mucoperichondrial flaps developed and carried posteriorly to vomer and perpendicular plate. The deviated segments of quadrangular cartilage, vomer, and perpendicular plate were excised using a horizontal double-action scissors. The flaps were then placed down after the septum was re-skeletonized with crushed autogenous cartilage. The septal mucoperichondrial flaps were then coapted to obliterate dead space using a horizontal 4-0 chromic mattress quilting suture. The hemitransfixion incision anteriorly was closed with an interrupted 4-0 chromic. A Stryker cryoablation unit was then employed to freeze the area of the sphenopalatine nerves bilaterally. The cold carbon dioxide elements was applied for 30 seconds to the lateral wall near the insertion of the middle turbinate and allowed to thaw for 15 seconds. The cryoablation was carried out on both sides. An intercartilaginous incision was made bilaterally and Joseph scissors used to dissect through the incision onto the dorsum of the nose where there was a regular bone. The dorsum was rasped appropriately and then medial and lateral osteotomies were performed with 4-mm straight curvatures. A nasal dorsum external splint of thrombogenic plastic was applied. This was secured with Steri-Strips. The nasal cavity was inspected and found to be quite clear with an open airway. Telfa gauze was placed in each nasal cavity. Silk sutures passed through each nasal packing were secured to the nasal dorsum. The thermogenic external plastic splint was applied and this was secured with Steri-Strips. An oropharyngeal pack which had been placed at the beginning of the procedure was removed and the oropharynx was suctioned. The patient was turned over to Anesthesia for uneventful extubation and transfer to the PACU, She tolerated this procedure well. There were no complications.
The patient was placed supine on the operating room table and general endotracheal anesthesia induced without difficulty. The head of the table was elevated 30 degrees above horizontal. The patient was draped with sterile linens. The nose was vasoconstricted with 4% cocaine on cottonoid pledgets and the nose was infiltrated with lidocaine 1% with 1:100,000 epinephrine. A time-out was called to confirm patient identity, site and type of procedure and any special circumstances. The pledgets were then removed and the nasal hairs trimmed. A throat pack was placed. A hemitransfixion incision was then made on the left side and mucoperichondrial flaps developed and carried posteriorly to vomer and perpendicular plate. The deviated segments of quadrangular cartilage, vomer, and perpendicular plate were excised using a horizontal double-action scissors. The flaps were then placed down after the septum was re-skeletonized with crushed autogenous cartilage. The septal mucoperichondrial flaps were then coapted to obliterate dead space using a horizontal 4-0 chromic mattress quilting suture. The hemitransfixion incision anteriorly was closed with an interrupted 4-0 chromic. A Stryker cryoablation unit was then employed to freeze the area of the sphenopalatine nerves bilaterally. The cold carbon dioxide elements was applied for 30 seconds to the lateral wall near the insertion of the middle turbinate and allowed to thaw for 15 seconds. The cryoablation was carried out on both sides. An intercartilaginous incision was made bilaterally and Joseph scissors used to dissect through the incision onto the dorsum of the nose where there was a regular bone. The dorsum was rasped appropriately and then medial and lateral osteotomies were performed with 4-mm straight curvatures. A nasal dorsum external splint of thrombogenic plastic was applied. This was secured with Steri-Strips. The nasal cavity was inspected and found to be quite clear with an open airway. Telfa gauze was placed in each nasal cavity. Silk sutures passed through each nasal packing were secured to the nasal dorsum. The thermogenic external plastic splint was applied and this was secured with Steri-Strips. An oropharyngeal pack which had been placed at the beginning of the procedure was removed and the oropharynx was suctioned. The patient was turned over to Anesthesia for uneventful extubation and transfer to the PACU, She tolerated this procedure well. There were no complications.