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A primary rhinoplasty, designated by CPT® Code 30420, is a surgical procedure aimed at reshaping the nose to enhance its appearance and function. This procedure is particularly significant when it includes major septal repair, often referred to as rhinoseptoplasty. Prior to the surgery, the physician conducts a thorough assessment, which includes taking photographs of the patient's nose to aid in planning the surgical approach. The rhinoplasty can be performed using two primary techniques: the closed technique, where all incisions are made inside the nostrils, or the open technique, which involves an additional incision across the columella, the tissue that separates the nostrils. During the procedure, the physician meticulously marks the skin of the nose, using the preoperative photographs as a reference to ensure precision in reshaping. The surgical steps involve reshaping the lateral and alar cartilages, elevating the nasal tip, and, if necessary, removing cartilage from the sides of the nose to address width issues. The nasal tip is sculpted to achieve a graceful projection from the dorsal bridge line. In cases where a complete rhinoplasty is indicated, the procedure may also involve reshaping the bony pyramid of the nose, incising the columella, and elevating the skin and soft tissue to access the underlying structures. For CPT® Code 30420, the focus is on the nasal septum, which is reshaped through an incision made inside the nostril. The mucosa is elevated to reveal the underlying bone and cartilage, allowing for necessary adjustments, including the removal of any spurs. If a cartilage graft is required, it is typically harvested from the septum itself. The procedure also includes repositioning a deviated septum to the midline of the nose. Following the reshaping of the septum and the rhinoplasty, the incisions are closed, and splints may be placed inside the nose to maintain the septum's position, with nasal packing utilized as needed to control postoperative bleeding.
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The primary rhinoplasty procedure, as described by CPT® Code 30420, is indicated for various conditions related to the structure and function of the nose. The following are explicitly provided indications for performing this procedure:
The procedure for CPT® Code 30420 involves several detailed steps to ensure effective reshaping of the nose and correction of the septum. The following procedural steps are outlined:
After the completion of the rhinoplasty with major septal repair, patients can expect specific post-procedure care and recovery considerations. It is common for patients to experience swelling and bruising around the nose and eyes, which typically subsides over time. Patients are advised to avoid strenuous activities and to follow specific instructions regarding nasal care, including the use of prescribed medications to manage pain and prevent infection. Follow-up appointments are essential to monitor healing and to remove any splints or packing as necessary. The physician will provide guidance on when normal activities can be resumed and any additional care required during the recovery period.
| Short Descr | RECONSTRUCTION OF NOSE | Medium Descr | RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR | Long Descr | Rhinoplasty, primary; including major septal repair | Status Code | Restricted Coverage | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 28 - Plastic procedures on nose |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AG | Primary physician | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | LT | Left side (used to identify procedures performed on the left side of the body) | SG | Ambulatory surgical center (asc) facility service |
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| Pre-1990 | Added | Code added. |
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