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A secondary rhinoplasty, commonly known as revision rhinoplasty, is a surgical procedure aimed at correcting or improving the results of a previous rhinoplasty. This type of surgery is typically performed when the initial rhinoplasty did not achieve the desired aesthetic or functional outcomes. Prior to the operation, the physician conducts a thorough evaluation of the previous surgical results, which informs the surgical plan for the revision. The procedure can be executed using either a closed technique, where all incisions are made inside the nose, or an open technique, which involves an additional incision across the columella, the tissue that separates the nostrils. During the surgery, the physician carefully marks the skin of the nose, often using pre-operative photographs as a reference to guide the reshaping process. The goal is to enhance the overall appearance of the nose, ensuring that it aligns harmoniously with the facial features. In the context of CPT® Code 30435, the intermediate revision involves more complex bony work, including osteotomies, which are surgical procedures that involve cutting and reshaping the bone. This level of revision may require the use of cartilage grafts harvested from the patient's ear or rib to provide additional support and structure to the nose. The procedure is designed to address both aesthetic concerns and any functional issues that may have arisen from the initial surgery.
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The indications for performing a secondary rhinoplasty, specifically under CPT® Code 30435, include the following:
The procedure for CPT® Code 30435 involves several detailed steps to ensure a successful intermediate revision rhinoplasty:
After the completion of the intermediate revision rhinoplasty, patients can expect specific post-procedure care and considerations. It is common for the surgeon to provide instructions regarding the care of the surgical site, including how to manage any swelling or bruising that may occur. Patients may be advised to avoid strenuous activities and to keep their head elevated to minimize swelling. Follow-up appointments are essential to monitor the healing process and to ensure that the nose is healing correctly. Nasal packing may be used to control bleeding, and splints may remain in place for a specified period to support the new nasal structure. The recovery timeline can vary, but patients should be informed about the expected duration of healing and any signs of complications that should prompt immediate medical attention.
| Short Descr | REVISION OF NOSE | Medium Descr | RHINOPLASTY SECONDARY INTERMEDIATE REVISION | Long Descr | Rhinoplasty, secondary; intermediate revision (bony work with osteotomies) | 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) | 2 - Payment restriction for assistants at surgery does not apply 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 |
| 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. | 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.) | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| Pre-1990 | Added | Code added. |
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