20 hours ago Terms in this set (35) A patient underwent endoscopic right maxillary antrostomy. Report CPT code (s) _____. 31256-RT. Acute and chronic laryngitis. Report code (s) _____. 464.00, 476.0. … >> Go To The Portal
The first code 31256 is reported for the work of a maxillary antrostomy only without removal of tissue while the second code 31267 includes removal of tissue from the maxillary sinus in addition to the maxillary antrostomy: CPT 31256: Nasal/sinus endoscopy, surgical, with maxillary antrostomy;
Full Answer
CPT code 31256 is correct for maxillary antrostomy without removal of tissue, however, 31267 is used when tissue is removed. For the left side, the combination code 31259-LT is reported. What is Endoscopic maxillary Antrostomy? This subset of patients often has persistent sinus disease despite medical therapy and adequate antrostomy.
This subset of patients often has persistent sinus disease despite medical therapy and adequate antrostomy. Endoscopic maxillary mega-antrostomy (EMMA) is a mucosal sparing technique that facilitates mucus clearance and sinus irrigation in terminally dysfunctional maxillary sinuses.
Endoscopic medial maxillectomy as a means of treating recalcitrant maxillary sinusitis was performed on 24 patients between 2009 and 2012 in the Sinus and Nose Hospital (Santhome, Chennai, India), which is a tertiary care center for nasal and sinus diseases.
Maxillary antrostomy has been practiced since the mid-1980s and is the most likely surgical approach to be performed if you have chronic sinusitis that is unresponsive to other medical therapies. In this case, the procedure is part of the endoscopic sinus surgery which may be your next best option.
Maxillary antrostomy is a surgical procedure to enlarge the opening (ostium) of the maxillary sinus. This allows for further surgical intervention within the maxillary sinus cavity as well as improved sinus drainage. Maxillary antrostomy has been practiced since the mid-1980s and is the most likely surgical approach to be performed if you have chronic sinusitis that is unresponsive to other medical therapies. In this case, the procedure is part of the endoscopic sinus surgery which may be your next best option. Standard medical therapies include an antibiotic trial (3-6 weeks), nasal steroids, and saline irrigations.
The osteomeatal complex is made up of the following four nasal structures: Uncinate process — is an L-shaped bone that will be removed. maxillary ostium (opening of the maxillary sinus) infundibulum — curved channel in the nose. ethmoid bulla — one of the ethmoid sinuses 1 .
It is important that your doctor remove the uncinate process at the beginning of the procedure in order to better visualize the maxillary sinus opening.
Osteomeatal complex obstruction — prevents drainage of the maxillary sinus. While this is a lot of technical medical terminology, all this information will provide your doctor with the information needed to be properly prepared for your surgical procedure. The osteomeatal complex is made up of the following four nasal structures:
Preparation for Endoscopic Sinus Surgery and Maxillary Antrostomy. Prior to surgery, you will have been instructed to have nothing to eat or drink from midnight the day of surgery until after the surgery is performed. This will help prevent your risk of inhaling stomach contents ( aspiration ).
accessory organs of the digestive system include the esophagus, Liver, gallbladder, and small intestine. False. Nasal endoscopy reveals cyst and mucocele of nose and nasal sinus. This is reported with. J43.1. When coding the phrase "occlusion of bile duct without cholelithiasis," the main term to reference is.
Mr. Bonaparte underwent bronchoscopy with transbronchial biopsy of the lung. Report code (s) _____.
Dr. Lewis treated an established patient in the office who complained of a 3-month history of fatigue and weight loss. Comprehensive history and exam were performed; medical decision making was of
An office consultation is performed for a postmenopausal woman who is complaining of spotting in the past 6 months with right lower quadrant tenderness. A detailed history and physical are performed with a
A patient underwent confirmation of three drugs by liquid chromatography mass spectrometry. Report
Endoscopic medial maxillectomy as a means of treating recalcitrant maxillary sinusitis was performed on 24 patients between 2009 and 2012 in the Sinus and Nose Hospital (Santhome, Chennai, India), which is a tertiary care center for nasal and sinus diseases. These patients had undergone multiple endoscopic surgeries elsewhere or in our center in the past but were still symptomatic. Patients included those with chronic sinusitis, nasal polyposis, AFRS, osteomyelitis, and persistent sinusitis following surgery and chemotherapy. All patients underwent a diagnostic nasal endoscopy. All of them had a wide middle meatal antrostomy, but the antral mucosa was found to be unhealthy with persistent disease. A methylene blue dye test was performed in these patients to evaluate the efficiency of the mucociliary clearance mechanism.
Results We performed modified endoscopic medial maxillectomies in 37 maxillary sinuses of 24 patients. The average age was 43.83 years. Average follow-up was 14.58 months. All patients had good disease control in postoperative visits with no clinical evidence of recurrences.
Medial maxillectomy through a lateral rhinotomy incision involves the removal of the lateral nasal wall, ethmoid labyrinth, and medial portion of the maxilla. It was the gold standard for the removal of inverted papilloma. It has the advantages of excellent exposure of the lateral nasal wall and paranasal sinuses.910Endoscopic modified medial maxillectomy is transnasal removal of uncinate process, bulla, inferior turbinate, middle turbinate, and medial maxillary wall with the nasolacrimal duct.7Hitherto endoscopic MMM was reserved for tumors of the maxillary sinus only.7In the recent times, this thinking is slowly but steadily changing and one finds a few reports of endoscopic medial maxillectomy for recalcitrant maxillary sinusitis.11121314Simmen and Jones described three types of maxillary sinsusotomy.15Type I involves widening of the natural ostium to a diameter of 1 cm. Type II involves widening it posteriorly and inferiorly to a maximum of 2 cm. Type III involves widening it close to the level of the posterior wall of the maxillary antrum and anterior to the lacrimal sac and inferiorly to the base of the inferior turbinate. They recommend type III for extensive sinus disease, antrochoanal polyp removal, and previous surgery. We feel that merely taking down the medial wall of the maxillary antrum does not serve the purpose in patients with irreversible mucosal injury and necessitates a more radical procedure like a type IIb MEMM. This is because the goblet cells keep secreting mucus, which accumulates in the sinus and leads to a “sump” effect. In patients with chronically diseased maxillary sinuses, poor mucociliary clearance may result from long-standing inflammation or scarring from previous surgery. This subset of patients often has persistent sinus disease despite medical therapy and adequate antrostomy. We are of the opinion that the mucociliary clearance is the single most important factor in determining the outcome in maxillary sinus after surgery. If the mucociliary clearance is competent, the sinus will function well; otherwise, the disease continues to persist. At present, there are no definitive guidelines for the treatment of this subset of patients. Woodworth et al reported in a retrospective review comprising 19 patients that MEMMs are both safe and an effective treatment for chronic maxillary sinusitis refractory to standard medical and endoscopic surgical management.11Wang et al reported complete resolution of the disease in 80% of their patients.12Cho and Hwang performed an endoscopic mega antrostomy, which involved extending the antrostomy through the posterior half of the inferior turbinate down to the floor of the nose, creating a significantly enlarged antrostomy in 28 patients; they reported a success rate of 74%.13An interesting study conducted by Shatz on 15 children with cystic fibrosis revealed marked improvement in sinus drainage and symptoms after medial maxillectomy and Caldwell-Luc.14
The medial wall of the maxillary sinus is removed right down to the nasal floor inferiorly and up to the posterior wall posteriorly. The anterior limit of dissection is the nasolacrimal duct. The anterior end of the inferior turbinate and the medial wall anterior to the nasolacrimal duct is preserved. The drainage of the sinus is by gravity. Postoperative nasal douching will be very effective for these patients. However, the inferior turbinate is resected to provide complete exposure of the maxillary sinus for drainage. The nasolacrimal duct should be identified and preserved. In case of inadvertent injury, it should be transposed higher, near the attachment of the middle turbinate (Fig. 1).
The aim of the surgery is to provide gravity-dependent drainage of the maxillary sinus. All procedures were done under general anesthesia. Preoperative packing was done with 4% lignocaine and ephedrine-soaked pledgets in all of our patients. Infiltration of 2% xylocaine with 1/200,000 adrenaline was given. We performed three types of modified endoscopic medial maxillectomies (MEMMs; see Table 1and Fig. 1). Type I and type IIa and b are performed for inflammatory disease of the maxillary sinus. Radical medial maxillectomy is reserved for maxillary sinus tumors, which falls outside the range of discussion in this article.
Preoperative CT scan is mandatory in all patients undergoing revision sinus surgery as it defines the bony anatomy (or rather the loss of it due to previous surgery) well.8The middle meatal antrostomy should be examined for aspects of retained uncinate process in the region of the natural ostium of the maxillary sinus or unventilated cells missed on the primary procedure, such as the infraorbital (Haller) cells.8The frontal recesses should be identified, and patency should be determined. Careful attention should be paid to the underlying bone for evidence of osteitis represented radiographically as thickened irregular bone.8
Average follow-up was 14.58 months. One patient had postoperative bleeding from the sphenopalatine artery, which was controlled in the operation theater by cauterization. One patient had hypoplastic maxillary sinus 6 months after surgery, though he remains asymptomatic at present. All patients had good disease control in the postoperative visits with no clinical evidences of recurrences.
The endoscopic middle meatal maxillary antrostomy is one of the most commonly performed endoscopic procedures. Despite this, at our tertiary institution, we commonly see failed antrostomies requiring revision surgery. Accordingly, we describe in a stepwise fashion strategies helpful in creating a patent and naturally function maxillary antrostomy.
Mucociliary clearance is most effective with the cilia beating in both directions, so in theory a small antrostomy provides the most effective clearance. On the other hand, concerns with a small antrostomy include postoperative edema, persistent obstruction and scar formation. At the current time, despite much debate, optimal maxillary antrostomy size remains unclear.
Our experience suggests that the uncinate process becomes involved in the inflammatory reaction early in the disease process. Accordingly, although it is possible to just dilate the maxillary sinus ostium with a balloon, at this point in time we believe that complete removal of the uncinate process is important in firmly established chronic disease. Unfortunately, the anterior margin of the uncinate process attaches to the nasolacrimal duct, a structure not readily visualized during intranasal surgery, and Bolger has previously demonstrated that injury to the nasolacrimal duct during antrostomy is common, although frequently asymptomatic. 2
Maxillary antrostomy is frequently believed to be the simplest portion of endoscopic sinus surgery. It is evident that this could not be further from the truth. Maxillary antrostomy is a challenging procedure because of the paucity of landmarks, the critical nature of the anterosuperior portion of the maxillary sinus ostium for mucociliary flow and the potential for significant bone neo-osteogenesis in this region. Using telescopes with significantly deflected angles of view, removal of osteitic bone while minimizing bone exposure and, when necessary, use of image guidance are all important adjuncts to avoiding persistent symptoms and surgical failure.