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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 of the secondary rhinoplasty is to enhance the nasal structure, which may involve reshaping the nasal tip to ensure it projects harmoniously from the dorsal bridge line. This may require the removal of cartilage or the placement of cartilage grafts, often sourced from the patient's ear or rib. The complexity of the procedure can vary significantly; in cases classified as major revisions, both nasal tip work and bony work are performed to achieve the desired results.
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The procedure is indicated for patients who have undergone a previous rhinoplasty and are seeking correction or enhancement of the nasal structure due to unsatisfactory results. Specific indications include:
The procedure involves several detailed steps to ensure a successful revision of the nasal structure. Each step is critical to achieving the desired aesthetic and functional outcomes.
After the procedure, patients are typically monitored for any immediate complications. Post-operative care may include instructions for managing swelling and discomfort, as well as guidelines for nasal care. Patients are advised to avoid strenuous activities and to follow up with their surgeon for assessments of healing and to ensure the desired outcomes are being achieved. The recovery period can vary, but patients should expect some swelling and bruising, which will gradually subside over time. Follow-up appointments are crucial for monitoring the healing process and addressing any concerns that may arise.
| Short Descr | REVISION OF NOSE | Medium Descr | RHINOPLASTY SECONDARY MAJOR REVISION | Long Descr | Rhinoplasty, secondary; major revision (nasal tip work and 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 |
| 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). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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| Pre-1990 | Added | Code added. |
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