Understanding Procedural Coding: Chapter 7 Respiratory System

Diagnostic thoracoscopy with biopsy of the mediastinal space

32606

Thoracic sympathectomy via thoracoscope

32664

Unilateral total lung lavage

32997

Intranasal biopsy

30100

Excision of an intranasal lesion via internal approach

30117

Complete excision of inferior turbinate

30130

CASE 4: This 24-year-old patient was brought to the emergency room with difficulty breathing after being stung by a bee. The patient is experiencing a severe reaction to the bee sting. She was able to administer to EpiPen but she is still in need of breathing assistance. An emergency tracheostomy was performed, after which the patient was resting comfortably.

31603

Transtracheal tracheostomy, emergency procedure

31603

CASE 9: Redundant scar tissue surrounding a tracheal stoma. PROCEDURE: Repair of the tracheal stoma. The patient was placed under general anesthesia, and the airway was established for proper ventilation during the procedure. An incision was make to resect the redundant scar tissue that had formed around the tracheal stoma. The skin was reanastomosed and closed in sutured layers. Blood loss was minimal. The patient was sent to the recovery area in satisfactory condition.

31613

Rigid bronchoscopy with fluoroscopic guidance with bronchial alveolar lavage

31624

CASE 7: Rule out malignant lesion of right upper lobe of bronchus. PROCEDURE: Under conscious sedation, this 82-year-old female was sedated. The airway was anesthetized, and a flexible bronchoscope has advanced though the oral cavity though the larynx using fluoroscopic guidance. The bronchus was viewed, and a lesion was identified. A biopsy of the tissue was taken from the right upper lobe of the bronchus. No other lesions were visualized. Bleeding was found to be minimal, and the scope was removed. The tissue sample was sent to pathology. The patient was sent to recovery area in stable condition.

31625

CASE 5: Procedure: Bronchoscopy with biopsy with washing Conscious sedation of Fentanyl, 20mcg, and 2 mg of Versed was administered to this patient. A bronchoscope was introduced though the left nostril and moved down past normal vocal cord structure and into the bronchial tree on the right side. There were no ulcerations of the mucosa. Fluoroscopic guidance allowed for the bronchoscope to move into the upper lobe of the right lung. Endobronchial biopsy of a small mass was noted, and washings and brushings were taken. Ther sample was sent for histology. The patient tolerated the procedure well.

31625, 31623

CASE 2: Removal of a foreign body in the broncus of the left lung via scope. The patient ws consciously sedated, and bronchoscope was introduced into the left nasal passage. There were no abnormall structures noted as the scope was placed into the left bronchial tree. In the left bronchial tree, there was a foreign body, and the bronchial tree appeared slightly inflamed. The foreign body was removed and sent to pathology for inspection. The scope was removed, and the patient tolerated the procedure and was sent to recovery in stable condition.

31635

Rigid bronchoscopy with bronchial thermoplasty

31660

Cervical tracheoplasty

31750

Revision of tracheostomy scar

31830

Pneumonostomy with open drainage of abscess

32200

CASE 3: This 32-year-old female was brought to the emergency department by her sister with right-side chest pain. Patient states that pain is between 9 and 10 on the pain scale. She as been having shortness of breath for the last four hours. She was fine yesterday except for a little fatigue. The pain started when she woke up this morning. A chest X-ray showed some suspicious area at the left base. At this time it was determined that a percutaneous needle biopsy of the lung should be completed. This procedure was preformed, and the patient is resting.

32405

Removal of lung, pneumonectomy

32440

Extrapleural pneumonectomy

32445

Single segment removal of lung

32484

There are two types of nasal endoscopies:_______ and _________.

diagnostic, surgical

The_______sinuses are located within the frontal bones behind the eyebrows

frontal

A primary rhinoplasty is also known as a(n)________ rhinoplasty.

inital

Surgical repairs of the________are known as rhinoplasty.

nose

The surgical puncturing of a lung for aspiration is a(n)________.

pneumocentesis

The removal of a lung is known as a(n)__________.

pneumonectomy

Secondary rhinoplasty is also known as_______ rhinopasty.

revision

A(n)_______is a surgical procedure in which an incision is made along one side of the nose.

rhinotomy

The_______sinuses are located directly behind the nose at the center of the skull.

sphenoid

The narrowing of the nasal vestibule is called________.

stenosis

CASE 8: Septorhinoplasty with major septal repair. The patient was plaved in the supine position under general anesthesia. This is the first time that this patient has undergone rhinoplasty. A cocaine-soaked pledget was placed in the nasal cavity, and the nasal septum and cartilaginous regions were exposed. After the blood vessels shrank, 1% Lidocaine with 1:100,000 epinephrine was injected into the nasal mucosa. The deformity was visualized via incisions noting the concave of the nasal septum. The cartilage was trimmed, and fat was removed from the subcutaneous regions. The dorsum was reshaped with files, and the periosteum was incised at the caudal aspect of the nasal bones, with a small portion of the bone resected. A vertical incision was made in the septal mucosa , and the cartilage was removed. All incisions were closed in single layers. The nose was dressed with the standard rhinoplasty dressing, and a Denver splint was placed to support the changes in the bone. Estimated blood loss was minimal. The patient was taken to the recovery area in stable condition.

30420

Transpalatine repair of choanal atresia

30545

Initial posterior control of nasal hemorrhage with posterior cautery

30905

CASE 6: This 76-year-old patient is being seen today because of spontaneous nasal hemorrhages. This patient has leukemia and is experiencing frequent bleeding from his nose. He was seen on Monday of this week, and I packed his nose with posterior nasal packing. HE returned today and is still bleeding, and I again posterior packed his nose to control the nasal hemorrhage. He was instructed to go directly to the emergency department if the bleeding increase at any point.

30906

Intranasal maxillary sinusotomy

31020

Total intranasal ethmoidectomy

31201

Maxillectomy

31225

Unilateral diagnostic nasal endoscopy

31231

Diagnostic nasal endoscopy with maxillary sinusoscopy

31233

Maxillary antrostomy using a sinus endoscope

31256

Medical orbital wall decompression via nasal endoscopy

31292

CASE 1: Laryngoscopy The patient was prepped and draped in the usual fashion and placed in the supine position. The operating table was turned to 90 degrees, and a donut headrest was used for stabilization. Mirrors were placed for indirect visualization. A laryngoscope was inserted and suspended for visualization. The larynx and the surrounding area were inspected, and a biopsy of the larynx was taken. Hemostasis was verified, and the scope was extracted. The patient tolerated the procedure and was sent to the recovery room.

31510

CASE 10: Postoperative diagnosis: Same as above; material sent to pathology. Procedure: This 69-year-old female was brought to the endoscopy suite and topical anesthesia was applied to the oral cavity and pharynx. The laryngoscope was then placed though the oral cavity into the laryngeal area. An aspirator device was fed though the scope and cleared of all saliva to better visualize the foreign body that was present. The foreign body was then removed and sent to pathology. The patient was stable and sent to the postprocedure area. There were no noted complications.

31530

Cricoid split laryngoplasty

31587