freespririt0806
Guru
hello , wondering if someone could check my coding here, I am looking at 69641-RT and 15769 H70.11- inner ear coding stumps me 
thanks in advance for any guidance
The patient was brought to the operating suite. Anesthesia was induced without difficulty. The patient, procedure, and laterality were confirmed. The right ear was prepped and draped, A clear drape was then used to drape the face so it could easily be seen. The canal was inspected, and a four-quadrant injection was performed as a postauricular injection with local and epinephrine. The postauricular incision was made and taken down to the attachment of the temporalis muscle. The dissection above the temporalis muscle was performed, and the fascia was gently freed and set to the side for grafting. With this being done, an incision was made along the temporal line at periosteum and inferiorly to the mastoid tip, and the periosteum was raised out to the posterior canal. With this being done, Wheat landers were now used to spread the soft tissue such that the cortex and the mastoid bone was identified. With this being done, a drill was used to make an incision along the temporal bone at the temporal line and parallel to the external auditory canal posteriorly. This was dissected in layers making the deepest part of the dish at the buttress of the zygoma. The tegmen was identified and djssection was kept along the tegmen. The external auditory canal wall was taken down, and the cholesteatoma was identified clearly. Biopsies were taken and sent to pathology. The dissection was then taken down to the mastoid tip; and at the sinodural angle, the connection was made with a mastoid tip such that the sigmoid sjnus was easily identified. Dissection was taken deeper and deeper making sure that the sinodural angle and mastoid tip were opened widely. I was able to reach the digastric ridge in the mastoid tip and eventually the horizontal semicircular canal came into visualization. as did the fossa
incudis. The disease was removed from the fossa incudis as best I could, but I could not see around the corner, and it appeared that it might be extending into the middle ear space. Therefore, decision was made to open up the facial recess. The deep posterior wall was then thinned out until I could see the course of the chorda tympani. Little inferior to this, the facial nerve was gently seen through the bone but drilling was not performed on the nerve itself. The external genu was identified, and a extending into the middle ear space was identified. The incus buttress was kept intact and once this was opened up, I was able to see the wound process of the incus and the stapes with the sac of the cholesteatoma clearly visible. I was thus able to deliver the cholesteatoma, and the remaining middle ear looked healthy. Once this had been determined, the middle ear space as well as the mastoid space was irrigated with copious amounts of bacitracin irrigation. At this point, closer inspection with a higher magnification revealed the superior ligament of the incus. I was unable to see the process as it was hjdden behind the buttress. The lenticular process of the incus and stapes were easily identified, and the horizontal segment of the fascial nerve Vll could be seen superiorly to the oval window. Once I was able to delineate this anatomy and felt that the cholesteatoma was clear, examination through the external auditory canal was performed, and inspection from above was performed. The tympanomeatal flap was created using a round knife and flicked anteriorly, and again I could not appreciate any disease. The part of the tympanlc membrane, which was involved with cholesteatoma, was trimmed with Bellucci scissors, and the middle ear space was filled with Gelfoam. A new graft was laid in place below the remaining portion of the tympanic membrane, which was laid over this. Once this was performed, a disc of Gelfoam was placed over this. This, however, was not performed until the posterior wall had been taken down to the chordae with a drill. At this point, I was happy with the middle ear space and the mastoid. However, the meatoplasty had to be performed, and incisions were made at 6 o'clock and 12 o'clock through the external auditory canal, and the cartilage posteriorly was removed. The tissue was then removed so that the skin could be flat posteriorly and admit the surgeon's thumb through the external auditory meatus. At this point, the entire ear was put back into its original position and closed in two layers, and a mastoid dressing was placed.
thanks in advance for any guidance
The patient was brought to the operating suite. Anesthesia was induced without difficulty. The patient, procedure, and laterality were confirmed. The right ear was prepped and draped, A clear drape was then used to drape the face so it could easily be seen. The canal was inspected, and a four-quadrant injection was performed as a postauricular injection with local and epinephrine. The postauricular incision was made and taken down to the attachment of the temporalis muscle. The dissection above the temporalis muscle was performed, and the fascia was gently freed and set to the side for grafting. With this being done, an incision was made along the temporal line at periosteum and inferiorly to the mastoid tip, and the periosteum was raised out to the posterior canal. With this being done, Wheat landers were now used to spread the soft tissue such that the cortex and the mastoid bone was identified. With this being done, a drill was used to make an incision along the temporal bone at the temporal line and parallel to the external auditory canal posteriorly. This was dissected in layers making the deepest part of the dish at the buttress of the zygoma. The tegmen was identified and djssection was kept along the tegmen. The external auditory canal wall was taken down, and the cholesteatoma was identified clearly. Biopsies were taken and sent to pathology. The dissection was then taken down to the mastoid tip; and at the sinodural angle, the connection was made with a mastoid tip such that the sigmoid sjnus was easily identified. Dissection was taken deeper and deeper making sure that the sinodural angle and mastoid tip were opened widely. I was able to reach the digastric ridge in the mastoid tip and eventually the horizontal semicircular canal came into visualization. as did the fossa
incudis. The disease was removed from the fossa incudis as best I could, but I could not see around the corner, and it appeared that it might be extending into the middle ear space. Therefore, decision was made to open up the facial recess. The deep posterior wall was then thinned out until I could see the course of the chorda tympani. Little inferior to this, the facial nerve was gently seen through the bone but drilling was not performed on the nerve itself. The external genu was identified, and a extending into the middle ear space was identified. The incus buttress was kept intact and once this was opened up, I was able to see the wound process of the incus and the stapes with the sac of the cholesteatoma clearly visible. I was thus able to deliver the cholesteatoma, and the remaining middle ear looked healthy. Once this had been determined, the middle ear space as well as the mastoid space was irrigated with copious amounts of bacitracin irrigation. At this point, closer inspection with a higher magnification revealed the superior ligament of the incus. I was unable to see the process as it was hjdden behind the buttress. The lenticular process of the incus and stapes were easily identified, and the horizontal segment of the fascial nerve Vll could be seen superiorly to the oval window. Once I was able to delineate this anatomy and felt that the cholesteatoma was clear, examination through the external auditory canal was performed, and inspection from above was performed. The tympanomeatal flap was created using a round knife and flicked anteriorly, and again I could not appreciate any disease. The part of the tympanlc membrane, which was involved with cholesteatoma, was trimmed with Bellucci scissors, and the middle ear space was filled with Gelfoam. A new graft was laid in place below the remaining portion of the tympanic membrane, which was laid over this. Once this was performed, a disc of Gelfoam was placed over this. This, however, was not performed until the posterior wall had been taken down to the chordae with a drill. At this point, I was happy with the middle ear space and the mastoid. However, the meatoplasty had to be performed, and incisions were made at 6 o'clock and 12 o'clock through the external auditory canal, and the cartilage posteriorly was removed. The tissue was then removed so that the skin could be flat posteriorly and admit the surgeon's thumb through the external auditory meatus. At this point, the entire ear was put back into its original position and closed in two layers, and a mastoid dressing was placed.