CPT® Code 30545

1. Indications

The procedure described by CPT® Code 30545 is indicated for the surgical repair of choanal atresia, particularly in the following scenarios:

• Bilateral Choanal Atresia This condition involves the obstruction of both posterior nasal passages, necessitating surgical intervention to restore normal airflow.
• Thick Bony Atresia In cases where the atresia is characterized by a significant bony obstruction, a transpalatine approach is preferred to effectively remove the obstructive tissue.
• Associated Anomalies The procedure is also indicated when choanal atresia is accompanied by other congenital anomalies affecting the anterior nasal cavities or nasopharynx, requiring a comprehensive surgical approach.

2. Procedure

The surgical procedure for CPT® Code 30545 involves several critical steps to effectively repair choanal atresia using a transpalatine approach:

• Step 1: Mucosal Incision A curved incision is made in the mucosa of the hard palate, providing access to the underlying structures necessary for the repair. This incision is strategically placed to minimize trauma to surrounding tissues.
• Step 2: Elevation of Mucosa The mucosa is carefully elevated to create an anterior flap, allowing the surgeon to visualize and access deeper anatomical layers. This step is crucial for ensuring a clear surgical field.
• Step 3: Exposure of Muscular Layer The muscular layer of the soft palate is exposed and incised at its insertion into the posterior edge of the hard palate. This incision facilitates further access to the obstructive tissue that needs to be removed.
• Step 4: Bone Removal Using a drill, the bone along the posterior edge of the hard palate, vomer, and pterygoid region is meticulously removed. This step is essential for eliminating the bony obstruction that characterizes choanal atresia.
• Step 5: Creation of Nasal Mucosal Flaps Nasal mucosal flaps are created and laid down adjacent to the anterior mucosal flap. These flaps are then imbricated, which helps to secure the new openings and promote healing.
• Step 6: Placement of Stents Stents are placed in the newly created choanal openings to maintain patency and are secured at the anterior ends. This ensures that the openings remain open during the healing process, facilitating normal airflow.

3. Post-Procedure

Post-procedure care following the repair of choanal atresia using CPT® Code 30545 involves monitoring for any complications and ensuring proper healing of the surgical site. Patients may require follow-up visits to assess the patency of the choanal openings and to manage any potential issues such as infection or scarring. It is important to provide appropriate pain management and to educate caregivers on signs of complications that may require immediate medical attention. The overall recovery process will vary depending on the individual patient's condition and the extent of the surgical intervention.