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The procedure described by CPT® Code 30630 involves the surgical repair of nasal septal perforations, which are openings or holes in the nasal septum, the cartilage and bone structure that separates the two nasal passages. This condition can lead to various complications, including nasal obstruction, crusting, and recurrent infections. The repair techniques for nasal septal perforations are diverse and can be tailored to the specific characteristics of the perforation and the patient's anatomy. Common methods include the use of prosthetic devices, local mucosal flaps, interposition grafts of connective tissue, tunneled sublabial mucosal flaps, and free flap repairs. When utilizing a local flap, the surgeon typically harvests tissue from adjacent healthy septal areas or the inferior turbinate, which is a structure within the nasal cavity. This harvested tissue may be combined with an interposition graft, which can consist of materials such as mastoid periosteum, cartilage, or ethmoid bone to enhance the repair's structural integrity. In cases where a sublabial mucosal flap is employed, the procedure involves elevating the mucoperichondrium around the perforation, followed by debridement of the perforation edges until active bleeding is observed. The upper lip is then exposed, and a flap of buccal mucosa is raised to create a pedicle flap, which is positioned laterally to the frenulum. This flap is subsequently tunneled through a surgically created sublabial-nasal fistula and placed over the septal perforation to achieve closure. The choice of technique depends on various factors, including the size and location of the perforation, as well as the overall health of the surrounding tissue.
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The procedure for repairing nasal septal perforations is indicated for patients experiencing complications associated with the presence of a perforation in the nasal septum. These complications may include:
The surgical repair of nasal septal perforations involves several detailed steps, which may vary based on the chosen technique. The following outlines the procedural steps:
Post-procedure care for patients who have undergone repair of nasal septal perforations typically includes monitoring for any signs of complications, such as infection or excessive bleeding. Patients are advised to avoid strenuous activities and to refrain from blowing their noses for a specified period to allow for proper healing. Follow-up appointments are essential to assess the success of the repair and to manage any ongoing symptoms. The surgeon may also provide specific instructions regarding nasal care and hygiene to support recovery.
| Short Descr | REPAIR NASAL SEPTUM DEFECT | Medium Descr | REPAIR NASAL SEPTAL PERFORATIONS | Long Descr | Repair nasal septal perforations | 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 | 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | 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 |
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| Pre-1990 | Added | Code added. |
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