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The procedure described by CPT® Code 30600 involves the surgical repair of an oronasal fistula, which is an abnormal connection between the oral cavity and the nasal cavity. This condition can lead to various complications, including difficulty in eating, speech issues, and recurrent infections. The repair process is intricate and typically employs a three-layer technique to ensure a robust closure of the defect. The first step involves creating a flap from the nasal septum, which is the wall dividing the two nostrils, using mucosal tissue from the side opposite the fistula. This flap is then maneuvered into the defect to close the nasal side. Following this, bone and cartilage are harvested from the nasal septum to provide structural support. The next phase of the procedure includes developing a second flap from the palatal mucosa, which is the tissue from the roof of the mouth. This flap is placed over the harvested bone and cartilage to effectively close the oral side of the defect. The meticulous nature of this procedure highlights the importance of surgical skill and precision in restoring normal anatomy and function for the patient.
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The oronasal fistula repair procedure is indicated for patients presenting with an abnormal passageway between the mouth and the nose, which can result from congenital conditions, trauma, or surgical complications. The following conditions may warrant this surgical intervention:
The surgical procedure for repairing an oronasal fistula involves several detailed steps to ensure effective closure of the defect. The following outlines the procedural steps:
After the oronasal fistula repair, patients typically require careful monitoring and follow-up care to ensure proper healing. Post-procedure care may include pain management, dietary modifications to avoid irritation of the surgical site, and instructions on oral hygiene to prevent infection. Patients are often advised to avoid strenuous activities and follow specific guidelines provided by the surgeon to promote optimal recovery. Follow-up appointments are essential to assess the healing process and address any complications that may arise.
| Short Descr | REPAIR MOUTH/NOSE FISTULA | Medium Descr | REPAIR FISTULA ORONASAL | Long Descr | Repair fistula; oronasal | Status Code | Active Code | 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) | 0 - 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 | 33 - Other OR therapeutic procedures on nose, mouth and pharynx |
| 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 | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | T5 | Right foot, great toe | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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