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Review Committee for Otolaryngology Case Log Coding Recommendations

The following Case Log Coding Recommendations have been provided in an attempt to establish some degree of uniformity for all Otolaryngology residents for logging cases into the ACGME Case Log System.

The Review Committee for Otolaryngology publicly thanks and credits the Harvard Otolaryngology Residency Program for drafting the initially proposed document which was utilized in the development of these recommendations, and the University of Michigan Program for the most recent revisions.

Please note that these recommendations additionally provide role definitions for Resident , Resident Assistant, and Resident Supervisor, and demarcate those procedural codes that define Key Indicator Cases (as indicated by red asterisks *). These cases constitute the 14 procedure categories identified by the RRC to be representative of Otolaryngology surgical training. Also included are instructions for the proper un-bundling of procedures (as indicated by blue text) for Case Log recording (but not billing) purposes.

This document contains a linkable Table of Contents for electronic use, but is also designed to print in booklet form (pages 2-9). This document will be periodically updated by the Review Committee for Otolaryngology based on updates to key indicator cases and procedures. Program directors will be notified of such updates via the RRC News for Otolaryngology or other correspondence.

Table of Contents

GENERAL//RHINOLOGY ...... 2 Emergency Department Procedures ...... 2 Postoperative Complications ...... 2 Endoscopy: Airway and Foreign Body Procedures ...... 2 Sinus ...... 3 General/Pediatric ...... 3 PEDIATRIC OTOLARYNGOLOGY ...... 4 LARYNGOLOGY ...... 4 HEAD & NECK SURGERY ...... 4 Endocrine Surgery ...... 4 Neck Dissection ...... 4 Salivary Gland Procedures ...... 5 Oral Cavity/Oropharynx ...... 5 ...... 5 Anterior Craniofacial Resection ...... 5 Maxillectomy ...... 6 Excision of Cutaneous Facial Lesion ...... 6 Head & Neck Ablative Procedures ...... 6 FACIAL PLASCTIC AND ...... 6 Free/Pedicled Flaps ...... 6 Plastics/Trauma Procedures ...... 6 Microtia Repair ...... 8 OTOLOGY/NEUROTOLOGY ...... 8 Otology ...... 8 Ablative Otologic Procedures ...... 8 Reconstructive Otologic Procedures ...... 9 Appendix: Key Indicator Categories ...... 10

1 *Asterisk by key indicator cases Epistaxis Control Rules for unbundling noted in blue Anterior epistaxis control (simple): 30901 Anterior epistaxis control (complex): 30903 Role Definitions: Posterior packing placement: 30905 Resident surgeon: performs ≥ 50% of the operation Revision posterior packing: 30906 with the attending or resident supervisor, Ethmoid artery ligation: 30915 including the key portions of the procedure Internal maxillary ligation, transantral: 30920 Resident assistant: performs < 50% of the operation, Endoscopic control, operative: 31238 or ≥ 50% of the operation but not the key portions of Septal / drainage: 30000 the procedure. hematoma/abscess: 69000 Resident supervisor: instructs/assists a more junior Oral vestibule drainage of cyst, abscess, resident during a procedure in which the junior hematoma: resident performs ≥ 50% of the operation, including the Simple: 40800 key portions of the procedure; the attending physician Complicated 40801 acts as an assistant or observer. Intraoral I&D abscess/cyst/hematoma: Lingual: 41000 GENERAL/ENDOSCOPY/RHINOLOGY Sublingual; superficial: 41005 Sublingual; deep: 41006 Emergency Department Procedures: Submental: 41007 Repair complex scalp laceration: Submandibular space: 41008 1.1-2.5cm: 13120 Sublingual/Submaxillary: 42310 2.6-7.5cm: 13121 Masticator space: 41009 Each additional 5cm Extraoral I&D abscess/cyst/hematoma: (code separate): 13122 Sublingual: 41015 Repair complex forehead/ laceration: Submental: 41016 1.1-2.5cm: 13131 Submandibular space: 41017 2.6-7.5cm: 13132 Masticator space: 41018 Each additional 5cm Parotid abscess I&D; simple: 42300 (code separate): 13133 Parotid abscess I&D; complicated: 42305 Repair complex eyelid//nose or Retropharyngeal/parapharyngeal laceration repair: abscess I&D; intraoral: 42720 <1.0 cm: 13150 Retropharyngeal/parapharyngeal 1.1-2.5 cm: 13151 abscess I&D; extraoral: 42725 2.6-7.5 cm: 13152 Each additional 5cm Postoperative Complications: (code separate): 13153 Neck exploration for hematoma: 35800 Open repair fracture: Postoperative tonsil bleed requiring OR: 42962 Depressed: 21343 I&D superficial abscess: 10060 Complicated: 21344 I&D deep space hematoma or abscess: 21501 Oral vestibule laceration repair: ≤2.5cm: 40830 Endoscopy: Airway / Foreign Body Procedures : >2.5cm: 40831 DL, diagnostic: 31525 FOM/Oral laceration repair: DL with : 31535 ≤2.5cm: 41250 DL w/ arytenoidectomy: 31560 >2.5cm 41252 MicroDL w/ arytenoidectomy: 31561 Flexible , diagnostic: 31575 Tracheoscopy or microlaryngoscopy Flexible laryngoscopy, w/ biopsy: 31576 with biopsy: 31536 *Flexible laryngoscopy, FB removal: 31577 *, diagnostic: 31622 * Flexible laryngoscopy, lesion removal: 31577 *Bronchoscopy with BAL: 31624 Peritonsillar abscess drainage: 42700 *Bronchoscopy with biopsy: 31625 Removal impacted cerumen: 69210 Awake fiberoptic intubation or Removal foreign body from ear: 69200 emergency intubation: 31500 Under GA (operative): 69205 Cricoidotomy: 31605 Removal of foreign body from nose: 30300 , planned: 31600 Under GA (operative): 30310 Tracheotomy, emergency: 31603 Tracheal repair: 31800

2 *DL with FB removal: 31530 Endo nasal: 31231 Micro DL, diagnostic: 31526 Endo CSF leak repair: *Micro DL with FB removal: 31531 Ethmoid region: 31290 Removal FB : 42809 Sphenoid region: 31291 Esophagoscopy with FB removal: 43215 CSF leak repair w/ : 61618 *Bronchoscopy with FB removal: 31635 (code graft harvest separately) DL w open reduction of fracture: 31584 Endo orbital wall decompression: *DL with dilation, initial: 31528 Medial or inferior wall: 31292 *subsequent: 31529 Medial and Inferior wall: 31293 *Bronchoscopy with dilation: 31630 Endo optic decompression: 31294 *Bronchoscopy with placement: 31631 *Revision 31638 Non-Endoscopic Sinus Surgery *Bronchoscopy with tumor excision: 31640 ; frontal: *Bronchoscopy with tumor or Trephine: 31070 laser ablation: 31641 Transorbital: 31075 *Tracheobronchoscopy through Frontal sinusotomy; obliterative: tracheostomy incision: 31615 Brow incision w/o osteoplastic flap: 31080 Esophagoscopy, diagnostic: 43200 Coronal incision w/o osteoplastic flap: 31081 Esophagoscopy, Brow incision w/ osteoplastic flap: 31084 w/ submucosal injection: 43201 Coronal incision w/ osteoplastic flap: 31085 w/ biopsy: 43202 Frontal sinusotomy; non-obliterative: w/ tumor removal 43217 Brow incision w/ osteoplastic flap: 31086 w/ insertion of stent/tube 43219 Coronal incision w/ osteoplastic flap: 31087 w/ dilation over guidewire 43226 Lavage by canulation; maxillary: 31000 Esophageal dilation Lavage by canulation; sphenoid: 31002 w/ balloon 43220 Sinusotomy; maxillary antrostomy: 31020 with bougie: 43450 Sinusotomy; Caldwell-Luc: 31030 over guidewire: 43453 Sinusotomy; Caldwell-Luc + polyps: 31032 retrograde: 45456 Sinusotomy: sphenoid+/- biopsy: 31050 PEG/ G-tube placement: 43246 Sinusotomy: sphenoid + polypectomy: 31051 Nasopharyngeal biopsy: 42806 Ethmoidectomy; intranasal, anterior: 31200 Zenker’s: Ethmoidectomy; intranasal, total: 31201 (endoscopic) 43499 Ethmoidectomy; extranasal, total: 31205 (open) 43130 (open cricopharyngeal- General/Pediatric: myotomy) 43030 Intranasal biopsy: 30100 Transcervical repair of esophageal Transnasal excision nasal polyp: / (open): 43410 Simple: 30110 Extensive: 30115 Sinus Surgery (log each side separately): Excision of intranasal lesion: Insertion of nasal button: 30220 Internal: 30117 Removal of FB; lateral rhinotomy: 30320 Lateral rhinotomy: 30118 Lysis of intranasal synechiae: 30560 Turbinate ablation; Endo maxillary antrostomy: 31256 Mucosal, any method: 30801 Endo maxillary antrostomy + tissue: 31267 Submucosal, any method: 30802 Endo frontal +/- tissue: 31276 Turbinate excision, any method: 30130 Endo sphenoid: 31287 Fracture inferior turbinate: 30930 Endo sphenoid + tissue: 31288 Turbinate, submucous resection: 30140 Endo biopsy or polyp or : 31237 Turbinate injection: 30200 Endo concha bullosa: 31240 : 30520 DCR: Frenotomy: 41010 Endo 31239 Frenuplasty; revision w/ Z-plasty: 41520 Open/fistulization 68720 UPPP: 42145 *Endo Ant ethmoid: 31254 Tongue base suspension: 41512 *Endo total ethmoid: 31255 Uvulectomy: 42140 Endo diag., maxillary b inf meatus: 31233 Chemical or thermal destruction of

3 or uvular lesion: 42610 Suspension microlaryngoscopy (SML) Uvula procedure NOS: 42299 with resection/stripping of polyp /tumor: 31541 T&A: *SML resection nodule/submucosal >12 yrs: 42821 mass w/ local flap recon: 31545 <12 yrs: 42820 *SML resection nodule/submucosal Tonsil alone mass w/ graft recon: 31546 > 12yrs: 42826 *SML with cordectomy: 31370 <12 yrs: 42825 *SML with endoscopic hemi laryngectomy: Adenoid alone: antero-vertical: 31380 > 12yrs: 42831 latero-vertical: 31375 <12yrs: 42830 antero-latero-vertical: 31382 M&T: VF injection / injection laryngoplasty: 31570 Myringotomy 69420 VF injection or injection laryngoplasty Myringotomy under GA 69421 (with microsope/telescope): 31571 Tube 69433 *Medialization thyroplasty: 31588 Tube under GA 69436 Triple procedure: Removal of ear tube under GA: 69424 Adduction arytenopexy: 31400 Medialization thyroplasty: 31588 PEDIATRIC OTOLARYNGOLOGY Cricothyroid subluxation: 31599 Pediatric Airway and Neck Office-based PDL: 31578 See also above codes for “Endoscopy: Airway and Office-based injection laryngoplasty: 31513 Foreign Body” Stroboscopy: 31579 DL / tracheoscopy in pediatric : 31536 Laryngeal EMG: 95865 MicroDL/Supraglottoplasty: 31541 *DL w/ insertion of obturator: 31527 *Diagnostic DL of newborn: 31520 *DL w/ dilation, initial: 31528 *Tracheotomy = <2y: 31601 *DL w/ dilation, subsequent: 31529 *Cricoid split: 31587 *Laryngoplasty for web; 2 stage w/ keel HEAD & NECK SURGERY insertion or removal: 31580 *LTR: 31582 Endocrine Surgery: -Rib graft: 20910 *Hemithyroidectomy: 60220 CTR / Trach R+R: 31780 *Hemithyroid; partial contralateral: 60225 *Laryngoplasty, NOS 31588 *Completion thyroidectomy: 60260 *Resection nasal dermoid: *Total thyroidectomy: 60240 *simple 30124 * Total thyroidectomy with pre-tracheal/ *complex 30125 prelaryngeal dissection: 60252 *Excision of vascular anomaly; *Total thyroidectomy with radical neck *w/o deep neurovascular dissection: 38550 dissection: 60254 *w/ deep neurovascular dissection: 38555 *Completion total thyroidectomy: 60260 *Branchial cleft anomaly not cyst: 42810 Code neck dissection separately. Thyroid case in *Branchial cleft cyst: 42815 which attending does most of the first lobe and you *Thyroglossal duct cyst: 60280 are surgeon on the other side: (Log two different *recurrent 60281 case IDs for each hemi thyroid - one as resident Choanal atresia repair: assistant and one as resident surgeon) Intranasal: 30540 *Parathyroid auto-transplantation: 60512 transpalatine: 30545 *Parathyroidectomy: 60500 Drainage of RP or PPS abscess *Parathyroidectomy; re-exploration: 60500 internal approach: 42720 external approach: 42725 Neck Dissection (log each side separately) Tongue fixation to lip for micrognathia: 41510 *MRND/SLND/SOHND: 38724 *Radical ND: 38720 LARYNGOLOGY excision: 42440 Deep cervical node biopsy/SLNB: 38510 DL w/ tumor excision or stripping vocal Dissection, jugular node(s): 38542 cord or : 31540 If you get into IJ/carotid and repair it: 35201 *MicroDL w/ arytenoidectomy: 31561 Excision soft tissue mass, neck: 21555

4 Excision tumor, deep neck: 21556 (anterior 2/3) 41112 Radical excision of malignant tumor, (posterior 1/3) 41113 anterior neck/thorax; <5cm: 21557 *Excision tongue lesion w/ tongue flap: 41114 Drainage of RP or PPS abscess Excision of frenulum: 41115 via external approach: 42725 Excision FOM lesion: 41116 Resection parapharyngeal space tumor: 61605 *Resection of RMT or OP tumor 42844 Vessel exploration: 35701 *Excision mandible tumor: 21045 Major vessel repair: 35201 Log neck dissection or tracheostomy separately if jointly performed with oral cavity/OP resection Salivary Gland Procedures: Tooth extraction: 41823 *Superficial parotid with FN dissection: 42415 Oroantral repair: *Superficial parotid w/o FN dissection: 42410 Oromaxillary: 30580 *Total parotid with FN dissection: 42420 Oronasal: 30600 *Total parotid with FN sacrifice: 42425 Limited Pharygectomy: 42890 -If you graft the FN: 64885 If you do a parotid/neck, log one of the above codes Laryngectomy: and log the neck procedure separately Laryngectomy (without neck dissection to keep If mass goes into parapharyngeal space, unbundled): 31360 also log: 61590 Hemilaryngectomy (horizontal): 31370 If abdominal fat graft following parotid: 20926 Hemilaryngectomy (laterovertical): 31375 Submandibular gland excision: 42440 Hemilaryngectomy (anterovertical): 31380 Selective neck dissection (levels 1A-1B):38724 Hemilaryngectomy (anterolaterovertical):31382 Sublingual gland excision: 42450 Epiglotidectomy: 31420 Ranula: Pharyngectomy: Excision: 42408 (when closed primarily) 42892 Marsupialization: 42409 (if requires flap for closure) 42894 Closure salivary fistula: 42600 Unbundle for laryngopharyngectomy Dilation salivary duct: 42650 Supraglottic laryngectomy: 31367 Dilation of salivary duct w/ catheter: 42660 -If you close the pharynx primarily Ligation salivary duct; intraoral: 42665 (pharyngoesophageal repair): 42953 Sialodochoplasty; -*If you take total thyroid: 60240 Primary or simple: 42500 -*If you take hemithyroid: 60225 Secondary or complicated: 42505 -*If you do MRND or SLND: 38724 Parotid duct diversion: 42507 -*If you do radical ND: 38720 -*If you do rotational SCM flap: 15732 Lip/ Oral Cavity/ Oropharynx: -*If you assist in PIG Lip Biopsy: 40490 (pharyngeal interposition graft): 15758 Vermillionectomy w/ advancement flap: 40500 TEP and prosthesis: 31611 Wedge excision; primary closure: 40520 Laryngofissue: Lip excision; >1/4 of lip: 40530 w/ tumor/laryngocele excision: 31300 Lip excision; local flap repair: 40525 diagnostic: 31320 Lip excision; cross lip repair: 40527 Cricopharyngeal myotomy: 43030 OC FB removal (embedded): Simple: 40804 Anterior Craniofacial Resection: Complicated: 40805 Pterygomaxillary fossa surgery; Biopsy of oral tongue: 41100 any approach: 31040 to be coded without neck dissection to Anterior craniofacial approach keep unbundled: and tumor resection w/o anterior *Partial glossectomy w/o primary cranial fossa resection: 61580 closure: 41120 Anterior craniofacial approach *Hemiglossectomy w/o primary and tumor resection w/ anterior closure: 41130 cranial fossa resection: 61582 *Total glossectomy: 41140 Orbitocranial approach to ant cranial Excision of oral tongue lesion without fossa (ACF): 61584 closure 41110 Bicoronal, transzygomatic or LeFort I Excision tongue lesion w/ primary closure: osteotomy approach to ACF: 61586

5 Resection/excision of ACF lesion: Tracheotomy: 31600 Extradural: 61600 If you explore neck for vessels Intradural +/- dural repair: 61601 (suprahyoid) 38700 + Orbital exenteration: 65110 neck dissection, log SLND Infratemporal fossa approach to see previous codes parapharyngeal space or middle *Excision of FOM lesion: 41116 cranial fossa: 61590 *Partial glossectomy: 41120 Infratemporal resection of tumor/mass: 61605 *Hemiglossectomy: 41130 Transpetrous approach to base: 61598 *Composite resection of tongue/FOM/mandible Resection of midline skull base (unbundle from neck): 41150 tumor/mass: 61607 *Mandible excision for: *ORN/benign tumor/cyst: 21047 If you put in a flap, code as under free/pedicled flaps *Malignant tumor : 21044 category *Segmental mandibulectomy: 21045 Auriculectomy; complete: 69120 Maxillectomy: Auriculectomy; partial: 69110 Maxillectomy Carotid body tumor excisions: (including total, inferior, or medial): 31225 Carotid sparing: 60600 If you take the eye: 65110 Carotid sacrifice: 60605 Placement of pin-borne prosthesis: 42281 FACIAL PLASTIC & RECONSTRUCTIVE Excision of cutaneous facial lesion: SURGERY Malignant face/eyelid/nose lesion <0.5 cm: 11640 Free/Pedicled Flaps: 0.6-1.0 cm: 11641 *RFFF (log assist if you help with inset): 15758 1.1-2.0 cm: 11642 *FFF (log assist if you help with inset): 20969 2.1-3.0 cm: 11643 *ALT (log assist if you help with inset): 15756 3.1-4.0 cm: 11644 *Pec Flap: 15734 >4.0 cm: 11646 *TPFF, or temporalis muscle flap, or Benign face/eyelid/nose lesion SCM rotational flap: 15732 <0.5 cm: 11440 *Cervico-facial rotational/advancement flap: 0.6-1.0 cm: 11441 if <10 cm2: 14060 1.1-2.0 cm: 11442 if 10-30 cm2: 14061 2.1-3.0 cm: 11443 if > 30cm2: 14300 3.1-4.0 cm: 11444 *Paramedian forehead flap: 15731 >4.0 cm: 11446 *Takedown of paramedian forehead flap Malignant Scalp/Neck Lesion pedicle (2nd stage) 15630 <0.5 cm: 11620 Free flap +/- vessel anastomosis: 0.6-1.0 cm: 11621 *Muscle or myocutaneous: 15756 1.1-2.0 cm: 11622 *Cutaneous: 15757 2.1-3.0 cm: 11623 *Fascia: 15758 3.1-4.0 cm: 11624 *Osteocutaneous: 20969 >4.0 cm: 11626 *Iliac crest: 20970 Benign Scalp/Neck Lesion If you scrub in only to close: <0.5 cm: 11420 -Close the arm: 0.6-1.0 cm: 11421 graft: 15100 1.1-2.0 cm: 11422 arm wound: 12035 2.1-3.0 cm: 11423 -*Advancement closure of leg 3.1-4.0 cm: 11424 (ie: fibula, ALT): 14021 >4.0 cm: 11426 -Close the chest (pec): 14001 Sentinel lymph node Box / Exec: 38510 -Close the neck: 12046 If you inject ethylene blue dye, add: 38792 -Close the parotid: 12055 Facial-hypoglossal nerve repair: 64868 Head & Neck Ablative Procedures: Diagnostic DL: 31525 Plastics / Trauma Procedures: DL with biopsy: 31535 Repair complex scalp laceration:

6 1.1-2.5cm: 13120 *Orbital floor fracture repair: 2.6-7.5cm: 13121 Caldwell-Luc approach: 21385 Each additional 5cm Periorbital approach: 21386 (code separate): 13122 + alloplastic or other implant: 21390 Repair complex forehead/face laceration: *Open : 1.1-2.5cm: 13131 Septoplasty: 30520 2.6-7.5cm: 13132 *Rhinoplasty: 30410 Each additional 5cm *Revision rhinoplasty: 30450 (code separate): 13133 *Nasal valve repair: 30465 Repair complex eyelid/ear/nose or lip *Repair of nasal vestibule stenosis 30465 laceration repair: graft: <1.0 cm: 13150 Septal cartilage graft: 20912 1.1-2.5 cm: 13151 Costochondral: 20910 2.6-7.5 cm: 13152 graft: Each additional 5cm Small or minor: 20900 (code separate): 13153 Large or major: 20902 Open repair frontal sinus fracture: Facial bone graft: 21210 Depressed: 21343 Cleft lip repair: Complicated: 21344 Primary: 40700 Closed reduction of nasal fracture: Secondary: 40720 Without stabilization: 21315 Cleft palate repair: With stabilization: 21320 : 42200 *Open reduction of nasal fracture: Palatoplasty w/ alveolar ridge: 42210 (log this as closed rhinoplasty Major revision: 42215 with bony work:) 30435 Palatoplasty w/ pharyngeal flap: 42225 *ZMC/midface fracture: 21360 Palatoplasty w/ island flap: 42227 (If done with Ophth, log orbital fx Rhytidectomy; forehead: 15824 as assist: 21390 Rhytidectomy: 15828 and log canthotomy if done: 67715 Rhytidectomy SMAS flap: 15829 *Closed alveolar fracture repair: 21440 Platysmectomy (platysmal tightening): 15825 *Open alveolar fracture repair: 21445 Cervicoplasty: 15819 *Percutaneous mandibular fracture Facial plastics Botox inj. (not ) 96372 repair; external fixation: 21452 Blepharoplasty: *Open mandibular fracture repair; (Log each eye and each site {upper or lower} external fixation: 21454 separately) *Mandible fracture: Upper blepharoplasty: 15823 (Log each aspect of case separately) Lower blepharoplasty: 15821 MMF: 21453 Repair of blepharoptosis: ORIF mandible fx: 21462 pexy: 67901 OR w/o fixation: 21461 Levator resection/advancement: 67904 *Open condylar fracture repair: 21465 Sup. rectus technique: 67906 *LeFort I fracture: Fasanella-Servat technique: 67908 Closed repair: 21421 Revision for overcorrection: 67909 Simple open repair: 21422 Correction of lid retraction: 67911 Complex open repair: 21423 Ectropion repair; *LeFort II fracture: Suture: 67914 Closed repair: 21345 Cautery: 67915 Simple open repair: 21346 Excision tarsal wedge: 67916 Complex open repair: 21347 Tarsal strip: 67917 *LeFort III fracture: Canthoplasty: 67950 Closed repair: 21431 (protruding ear): 69300 Simple open repair: 21432 Brow lift (any approach): 67900 Complex open repair: 21433 Eyelid weight: 67912 *Percutaneous malar/tripod fx repair: 21355 Removal of eyelid weight: 67912 *Gilles approach to fx: 21356 Vestibuloplasty: *Open zygomatic arch/tripod fx repair: 21365 Anterior: 40840

7 Posterior: 40840 Microtia repair Entire arch: 40844 1st stage with rib graft: 21230 Complex 40845 *2nd stage lobule transposition: 14061 Gracilis free flap: Unbundle as appropriate *3rd stage elevation of auricle w/ STSG: 14061 Myogenous free flap for paralyzed face: 15842 STSG (code separately): 15120 Temporalis tendon transfer: 15845 Dermabrasion: 15781 Neurorrhaphy: 64868 Chemical peel: 15788 Nerve graft harvest: ≤4cm graft: 64885 OTOLOGY/NEUROTOLOGY >4cm graft: 64886 Fascia lata graft: 20922 Otology *Stapes 69660 STSG to face *Revision Stapes: 69662 (eyelids, nose, , , ,neck): 15120 *Stapes mobilization: 69650 Dermal graft; face or neck: 15135 ME Exploration (postauric or transcanal):69440 Derma-fat-fascia graft: 15770 Cochlear Implant (two codes): *FTSG Insertion: 69930 (including closure of donor site, scalp, arms or legs): *Mastoidectomy: 69502 ≤ 20cm2: 15220 Replace BAHA: 69717 2 Implant BAHA: 69714 ≥ 20cm or part thereof: 15221 with STSG: 15120 *FTSG decompression; partial: 69720 (including closure of donor site forehead, *Facial nerve decompression; total: 69955 cheeks, , mouth, neck): Suture repair of intramastoid CN VII: 69740 ≤ 20cm2: 15240 (code decompression/mastoid and nerve graft ≥ 20cm2 or part thereof: 15241 harvest separately) Endolymphatic sac decomps + shunts (two codes): *FTSG Sac Decompression: 69806 (including closure of donor site to nose, ears, eyelids): 2 *Mastoidectomy: 69502 ≤ 20cm : 15260 Glomus tumor excision: ≥ 20cm2 or part thereof: 15261 Transcanal: 69550 *Composite Graft (ie: full-thickness of Transmastoid: 69552 external ear or including primary closure Extended (extratemporal): 69554 of donor site) 15760 (code neck approach separately) Acellular dermal replacement: 15175 Eust Tube Catheter, transnasal: 69400 *Autologous Ear cartilage graft (to nose or ear): 21235 Ablative Otologic Procedures Liposuction of head and neck: 15876 *** need to unbundle and log separately Adjacent tissue transfer/rearrangement: tympanoplasty, mastoidectomy, and/or OCR Scalp; ≤10 sq cm: 14020 from a key indicator case recording standpoint

Scalp; >10 sq cm: 14021 *Simple mastoid: 69501 Any site >30 sq cm: 14300 *Complete mastoid (CWU): 69502 *Paramedian forehead flap: 15731 *MR Mastoid (CWD stapes +/-malleus, *Takedown paramedian forehead flap: 15730 incus intact): 69505 Moh’s reconstruction (tissue rearrangement, *Radical mastoid advancement, rotational flaps): (CWD all ossicles taken): 69511 *eyelids, nose, ear, lips Mastoid bowl debridement; complex: 69222 <10 sq cm: 14060 *Petrous apicectomy: 69530 10-30 sq cm: 14061 *Revise mastoid to complete: 69601 *forehead, cheek, chin, mouth, lips *Revise mastoid to Mod rad: 69602 <10cm2: 14040 *Revise mastoid to Rad: 69603 10-30cm2: 14041 *Mastoid obliteration: 69670 *takedown of melolabial flap pedicle: 15630 Lateral TB resection: 69535 contracture release: 15003 Excision of EAC lesion: 69145

Radical excision EAC lesion: 69150

8 *Radical excision EAC lesion + neck dissection: 69155 (code neck dissection separately) Auriculectomy: 69120 CPA tumor: Suboccipital/Retrosig: 61520 *Translabyrinthine approach: 61596 *Middle cranial fossa approach: 61530 Resection of petrous apex lesion: Extradural: 61605 Intradural: 61606 Vestibular nerve section: Translabyrinthine approach: 69915 Transcranial approach: 69950 Endolymphatic sac decompression: w/ shunt: 69805 w/o shunt: 69806 Labyrinthectomy: 69910

Reconstructive otologic procedures: Meatoplasty: 69310 STSG: 15120 *Myringoplasty: 69620 Exostoses/Canalplasty: 69140 Canalplasty for atresia: 69320 *Tymp without OCR: 69631 *Tymp with OCR: autologous tissue 69632 TORP or PORP 69633 *Tymp with mastoid and OCR: 69642 (code tymp/OCR and mastoid separate) CSF leak dura repair w/ graft: 61618 (code graft separately)

The following appendix contains the 14 current key indicator case categories and the complete list of constituent key indicator case codes

9 APPENDIX: Key Indicator Case Categories Bronchoscopy (rigid or flexible); with destruction of tumor or relief of stenosis by any method other than excision (e.g., laser therapy, cryotherapy): 31641 Congenital Neck Masses

Excision branchial cleft cyst or vestige, Bronchoscopy (rigid or flexible); with injection of contrast confined to skin and subcutaneous tissues: 42810 material for segmental

( only): 31656 Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues Tracheobronchoscopy through established tracheostomy and/or into pharynx: 42815 incision: 31615

Excision dermoid cyst, nose; simple, skin, Bronchoscopy, rigid or flexible, with or without fluoroscopic subcutaneous: 30124 guidance; diagnostic, with or without cell washing

(separate procedure): 31622 Excision dermoid cyst, nose; complex, under bone or cartilage: 30125 Airway

Laryngoscopy direct, with or without tracheoscopy; Excision of vascular anomaly, axillary or cervical; diagnostic, newborn: 31520 without deep neurovascular dissection: 38550

Laryngoscopy, flexible fiberoptic; with removal of Excision of vascular anomaly, axillary or cervical; foreign body: 31577 with deep neurovascular dissection: 38555

Laryngoscopy, flexible fiberoptic; with removal Excision of thyroglossal duct cyst or sinus: 60280 of lesion: 31578

Excision of thyroglossal duct cyst or sinus; recurrent: 60281 Arytenoidectomy or arytenoidopexy,

external approach: 31400 Bronchoscopy

Bronchoscopy, rigid or flexible, with or without fluoroscopic Laryngoscopy direct, with or without guidance; with brushing or protected brushings: 31623 tracheoscopy; with insertion of obturator: 31527

Bronchoscopy, rigid or flexible, with or without fluoroscopic Laryngoscopy direct, with or without guidance; with bronchial alveolar lavage: 31624 tracheoscopy; with dilation, initial: 31528

Bronchoscopy, rigid or flexible, with or without fluoroscopic Laryngoscopy direct, with or without t guidance; with bronchial or endobronchial biopsy(s), single racheoscopy; with dilation, subsequent: 31529 or multiple sites: 31625

Laryngoscopy, direct, operative, with Bronchoscopy, rigid or flexible, with or without fluoroscopic foreign body removal: 31530 guidance; with tracheal/bronchial dilation or closed reduction of fracture: 31630 Laryngoscopy, direct, operative, with

foreign body removal; with operating Bronchoscopy, rigid or flexible, with or without fluoroscopic microscope or telescope: 31531 guidance; with placement of tracheal stent(s) (includes tracheal/bronchial dilation as required): 31631 Laryngoscopy, direct, operative, with

operating microscope or telescope, with Bronchoscopy, rigid or flexible, with or without fluoroscopic submucosal removal of non-neoplastic guidance; with removal of foreign body: 31635 lesion(s) of vocal cord; reconstruction with

local tissue flap(s): 31545 Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with placement of bronchial stent(s) Laryngoscopy, direct, operative, with (includes tracheal/bronchial dilation as required), operating microscope or telescope, with initial : 31636 submucosal removal of non-neoplastic

lesion(s) of vocal cord; reconstruction with Bronchoscopy, rigid or flexible, with or without fluoroscopic graft(s) (includes obtaining autograft): 31546 guidance; with revision of tracheal or bronchial stent inserted at previous session (includes tracheal/bronchial dilation as Laryngoscopy, direct, operative, with required): 31638 arytenoidectomy; with operating microscope

or telescope: 31561 Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with excision of tumor: 31640 Laryngoscopy, direct, with injection into vocal cord(s), therapeutic: 31570

10

Glossectomy; partial, with unilateral Laryngoscopy, direct, with injection into vocal cord(s), radical neck dissection: 41135 therapeutic; with operating microscope or telescope: 31571 Glossectomy; complete or total, with Unlisted procedure, larynx: 31599 or without tracheostomy, without radical neck dissection: 41140 Laryngoplasty; for laryngeal web, two stage, with keel insertion and removal: 31580 Glossectomy; complete or total, with or without tracheostomy, with unilateral Laryngoplasty; for laryngeal stenosis, with graft or radical neck dissection: 41145 core mold, including tracheotomy: 31582 Excision of lesion of tongue with Laryngoplasty, cricoid split: 31587 closure; posterior one-third: 41113

Laryngoplasty, not otherwise specified Excision of lesion of tongue with (e.g. medialization laryngoplaty; for , closure; with local tongue flap: 41114 reconstruction after partial laryngectomy): 31588 Excision of malignant tumor of Ethmoid mandible: 21044 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior): 31254 Excision of malignant tumor of mandible; radical resection: 21045 Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior): 31255 Excision of benign tumor or cyst of mandible; requiring extra-oral osteotomy and partial mandibulectomy (e.g., Ethmoidectomy; intranasal, anterior: 31200 locally aggressive or destructive lesion(s)): 21047

Ethmoidectomy; intranasal, total: 31201 Glossectomy; composite procedure with resection floor of mouth and mandibular resection, without radical neck Ethmoidectomy; extranasal, total: 31205 dissection: 41150

Thyroid Glossectomy; composite procedure with Parathyroidectomy or exploration of parathyroid(s): 60500 resection floor of mouth, with suprahyoid neck dissection: 41153 Parathyroidectomy or exploration of parathyroid(s); re-exploration: 60502 Glossectomy; composite procedure with resection floor of mouth, mandibular Parathyroid : 60512 resection, and radical neck dissection (Commando type): 41155 Total thyroid lobectomy, unilateral; with or without isthmusectomy: 60220 Neck Dissection Suprahyoid lymphadenectomy: 38700 Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy: 60225 Cervical lymphadenectomy (modified radical neck dissection): 38724 Thyroidectomy, total or complete: 60240 Cervical lymphadenectomy Thyroidectomy, total or subtotal for malignancy; (complete/RND): 38720 with limited neck dissection: 60252 Glossectomy; composite procedure with Thyroidectomy, total or subtotal for malignancy; resection floor of mouth, with suprahyoid with radical neck dissection: 60254 neck dissection: 41153

Thyroidectomy, removal of all remaining thyroid Thyroidectomy, total or subtotal for tissue following previous removal of a portion malignancy; with limited neck dissection: 60252 of thyroid: 60260 Laryngectomy; total, with radical neck Resection Oral Cavity dissection: 31365 Glossectomy; less than 1/2 tongue: 41120 Laryngectomy; subtotal supraglottic, with Glossectomy; hemiglossectomy: 41130 radical neck dissection: 31368

11 Revision mastoidectomy; resulting in complete Pharyngolaryngectomy, with radical neck dissection; mastoidectomy: 69601 without reconstruction: 31390 Revision mastoidectomy; resulting in modified radical Pharyngolaryngectomy, with radical neck dissection; mastoidectomy: 69602 with reconstruction: 31395 Revision mastoidectomy; resulting in radical Glossectomy; partial, with unilateral radical neck mastoidectomy: 69603 dissection: 41135 Revision mastoidectomy; resulting in Glossectomy; complete or total, with or without tympanoplasty: 69604 tracheostomy, with unilateral radical neck dissection: 41145 Revision mastoidectomy; with apicectomy: 69605 Glossectomy; composite procedure with resection floor of mouth, mandibular resection, and radical neck dissection Tympanoplasty with antrotomy or mastoidotomy (including (Commando type): 41155 canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); without ossicular chain Excision of parotid tumor or parotid gland; total, with reconstruction: 69635 unilateral radical neck dissection: 42426 Tympanoplasty with antrotomy or mastoidotomy (including Thyroidectomy, total or subtotal for malignancy; with radical canalplasty, atticotomy, middle ear surgery, and/or neck dissection: 60254 tympanic membrane repair); with ossicular chain reconstruction: 69636 Radical excision external auditory canal lesion; with neck dissection: 69155 Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or Parotid tympanic membrane repair); with ossicular chain Excision of parotid tumor or parotid gland; lateral lobe, reconstruction and synthetic prosthesis (e.g., partial without nerve dissection: 42410 ossicular replacement prosthesis (PORP), total ossicular replacement prosthesis (TORP)): 69637 Excision of parotid tumor or parotid gland; lateral lobe, with dissection and preservation of facial nerve: 42415 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); without Excision of parotid tumor or parotid gland; total, with ossicular chain reconstruction: 69641 dissection and preservation of facial nerve: 42420 Tympanoplasty with mastoidectomy (including canalplasty, Excision of parotid tumor or parotid gland; total, en bloc middle ear surgery, tympanic membrane repair); with removal with sacrifice of facial nerve: 42425 ossicular chain reconstruction: 69642

Excision of parotid tumor or parotid gland; total, with Tympanoplasty with mastoidectomy (including canalplasty, unilateral radical neck dissection: 42426 middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain Mastoid reconstruction: 69643 Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor; combined with Tympanoplasty with mastoidectomy (including canalplasty, middle/posterior fossa craniotomy/craniectomy: 61530 middle ear surgery, tympanic membrane repair); with intact or reconstructed canal wall, with ossicular chain Transcochlear approach to posterior cranial fossa, jugular reconstruction: 69644 foramen or midline skull base, including labyrinthectomy, decompression, with or without mobilization of facial nerve Tympanoplasty with mastoidectomy (including canalplasty, and/or petrous carotid artery: 61596 middle ear surgery, tympanic membrane repair); radical or complete, without ossicular chain reconstruction: Transmastoid antrotomy (simple mastoidectomy): 69501 69645

Mastoidectomy; complete: 69502 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or Mastoidectomy; modified radical: 69505 complete, with ossicular chain reconstruction: 69646

Mastoidectomy; radical: 69511 Mastoid obliteration (separate procedure): Petrous apicectomy including radical 69670 mastoidectomy: 69530 Total facial nerve decompression and/or repair

12 (may include graft): 69955 Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without Stapedectomy/Ossicular Chain Reconstruction ossicular chain reconstruction: 69631 Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or Tympanoplasty without mastoidectomy revision; with ossicular chain reconstruction (including canalplasty, atticotomy and/or (e.g, postfenestration): 69632 middle ear surgery), initial or revision; with ossicular chain reconstruction ( Tympanoplasty without mastoidectomy (including e.g., postfenestration): 69632 canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic Tympanoplasty without mastoidectomy prosthesis (e.g., partial ossicular replacement prosthesis (including canalplasty, atticotomy and/or (PORP), total ossicular replacement prosthesis middle ear surgery), initial or revision; with (TORP)): 69633 ossicular chain reconstruction and synthetic prosthesis (e.g., partial ossicular replacement Tympanoplasty with antrotomy or mastoidotomy (including prosthesis (PORP), total ossicular replacement canalplasty, atticotomy, middle ear surgery, and/or tympanic prosthesis (TORP)): 69633 membrane repair); with ossicular chain reconstruction: 69636 Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear Tympanoplasty with antrotomy or mastoidotomy (including surgery, and/or tympanic membrane repair); canalplasty, atticotomy, middle ear surgery, and/or tympanic without ossicular chain reconstruction: 69635 membrane repair); with ossicular chain reconstruction and synthetic prosthesis (e .g, partial acicular replacement Tympanoplasty with antrotomy or mastoidotomy prosthesis (PORP), total ossicular replacement (including canalplasty, atticotomy, middle ear prosthesis (TORP)): 69637 surgery, and/or tympanic membrane repair); with ossicular chain reconstruction: 69636 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with Tympanoplasty with antrotomy or mastoidotomy ossicular chain reconstruction: 69642 (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); Tympanoplasty with mastoidectomy (including canalplasty, with ossicular chain reconstruction and synthetic middle ear surgery, tympanic membrane repair); with intact prosthesis (e. g, partial ossicular replacement or reconstructed canal wall, with ossicular chain prosthesis (PORP), total ossicular replacement reconstruction: 69644 prosthesis (TORP)): 69637

Tympanoplasty with mastoidectomy (including canalplasty, Tympanoplasty with mastoidectomy middle ear surgery, tympanic membrane repair); radical or (including canalplasty, middle ear surgery, complete, with ossicular chain reconstruction: 69646 tympanic membrane repair); without ossicular chain reconstruction: 69641 Stapes mobilization: 69650 Tympanoplasty with mastoidectomy Stapedectomy or stapedotomy with reestablishment of (including canalplasty, middle ear surgery, ossicular continuity, with or without use of tympanic membrane repair); with ossicular foreign material: 69660 chain reconstruction: 69642

Stapedectomy or stapedotomy with reestablishment of Tympanoplasty with mastoidectomy ossicular continuity, with or without use of foreign material; (including canalplasty, middle ear surgery, with footplate drill out: 69661 tympanic membrane repair); with intact or Revision of stapedectomy or stapedotomy: 69662 reconstructed wall, without ossicular chain reconstruction: 69643 Tympanoplasty Revision mastoidectomy; resulting in Tympanoplasty with mastoidectomy (including canalplasty, tympanoplasty: 69604 middle ear surgery, tympanic membrane repair); with intact or reconstructed canal wall, with ossicular chain Tympanic membrane repair, with or without site preparation reconstruction: 69644 of perforation for closure, with or without patch: 69610 Tympanoplasty with mastoidectomy (including canalplasty, Myringoplasty (surgery confined to drumhead and donor middle ear surgery, tympanic membrane repair); radical or area): 69620 complete, without ossicular chain reconstruction: 69645

13 Forehead flap with preservation of vascular pedicle (e.g., Tympanoplasty with mastoidectomy (including canalplasty, axial pattern flap, paramedian forehead flap): 15731 middle ear surgery, tympanic membrane repair); radical or complete, with ossicular chain reconstruction: 69646 Muscle, myocutaneous, or fasciocutaneous flap; head and neck (e.g., temporalis, masseter muscle, Flaps sternocleidomastoid, levator scapulae): 15732 Free muscle or myocutaneous flap with microvascular anastomosis: 15756 Muscle, myocutaneous, or fasciocutaneous flap; trunk: 15734 Free skin flap with microvascular anastomosis: 15757 FTSG, including direct closure of donor site, scalp, arms Free fascial flap with microvascular anastomosis: 15758 and/or legs 20 cm² or less: 15220

Free osteocutaneous flap with microvascular anastomosis; FTSG including direct closure of donor site, scalp, arms other than iliac crest, metatarsal, or great toe: 20969 and/or legs; each additional 20 cm² or part thereof: 15221 Free osteocutaneous flap with microvascular anastomosis; iliac crest: 20970 FTSG including direct closure of donor site, forehead cheeks, chin, mouth, and neck ≤ 20 cm²: 15240 Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less: 14020 FTSG including direct closure of donor site, forehead cheeks, chin, mouth, and neck; each additional 20 cm² or Adjacent tissue transfer or rearrangement, scalp, arms part thereof: 15241 and/or legs; defect 10.1 sq cm to 30.0 sq cm: 14021 FTSG, including direct closure of donor site to nose ears Adjacent tissue transfer or rearrangement, forehead, cheeks, eyelids and/or let's 20 cm² or less: 15260 chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less: 14040 FTSG, including direct closure of donor site to nose ears eyelids each additional 20 cm² apart thereof: 15261 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; Composite Graft (i.e. full-thickness of external ear or nasal defect 10.1 sq cm to 30.0 sq cm: 14041 ala, including primary closure donor area): 15760

Adjacent tissue transfer or rearrangement, eyelids, nose, Ear cartilage graft autogenous to nose or ear: 21235 ears and/or lips; defect 10 sq cm or less: 14060 Mandible/ Adjacent tissue transfer or rearrangement, eyelids, nose, Closed treatment of mandibular or maxillary alveolar ridge ears and/or lips; defect 10.1 sq cm to 30.0 sq cm: 14061 fracture (separate procedure): 21440

Adjacent tissue transfer or rearrangement, more than 30 sq Open treatment of mandibular or maxillary alveolar ridge cm, unusual or complicated, any area: 14300 fracture (separate procedure): 21445

Formation of direct or tubed pedicle, with or without transfer; Closed treatment of mandibular fracture; without scalp, arms, or legs: 15572 manipulation: 21450 Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks, chin, mouth, neck, axillae, genitalia, Closed treatment of mandibular fracture; with hands or feet: 15574 manipulation: 21451

Formation of direct or tubed pedicle, with or without transfer; Percutaneous treatment of mandibular fracture, with eyelids, nose, ears, lips, or intraoral: 15576 external fixation: 21452

Delay of flap or sectioning of flap (division and inset); at Closed treatment of mandibular fracture with interdental scalp, arms, or legs: 15610 fixation: 21453

Delay of flap or sectioning of flap (division and inset); at Open treatment of mandibular fracture with external forehead, cheeks, chin, neck, axillae, genitalia, hands, or fixation: feet: 15620 21454

Delay of flap or sectioning of flap (division and inset); at Open treatment of mandibular fracture; without interdental eyelids, nose, ears, or lips: 15630 fixation: 21461

14 Open treatment of mandibular fracture; with interdental Closed treatment of fracture of , except blowout; with fixation: 21462 manipulation: 21401

Open treatment of mandibular condylar fracture: Open treatment of fracture of orbit, except blowout; 21465 without implant: 21406

Open treatment of complicated mandibular fracture by Open treatment of fracture of orbit, except blowout; with multiple surgical approaches including internal fixation, implant: 21407 interdental fixation, and/or wiring of dentures or splints: 21470 Open treatment of fracture of orbit, except blowout; with bone grafting (includes obtaining graft): 21408 Closed treatment of nasomaxillary complex fracture (LeFort II type), with interdental wire fixation or fixation of denture or Closed treatment of palatal or maxillary fracture (LeFort I splint: 21345 type), with interdental wire fixation or fixation of denture or splint: 21421 Open treatment of nasomaxillary complex fracture (LeFort II type); with wiring and/or local fixation: 21346 Open treatment of palatal or maxillary fracture (LeFort I type): 21422 Open treatment of nasomaxillary complex fracture (LeFort II type); requiring multiple open approaches: 21347 Open treatment of palatal or maxillary fracture (LeFort I type); complicated (comminuted or involving cranial nerve Open treatment of nasomaxillary complex fracture (LeFort II foramina), multiple approaches: 21423 type); with bone grafting (includes obtaining graft): 21348 Closed treatment of craniofacial separation (LeFort III Percutaneous treatment of fracture of malar area, including type) using interdental wire fixation of denture or splint: zygomatic arch and malar tripod, with manipulation: 21355 21431

Open treatment of depressed zygomatic arch fracture (e.g., Open treatment of craniofacial separation (LeFort III type); Gillies approach): 21356 with wiring and/or internal fixation: 21432

Open treatment of depressed malar fracture, including Open treatment of craniofacial separation (LeFort III type); zygomatic arch and malar tripod: 21360 complicated (eg, comminuted or involving cranial nerve foramina), multiple surgical approaches: 21433 Open treatment of complicated (e.g., comminuted or involving cranial nerve foramina) fracture(s) of malar area, Open treatment of craniofacial separation (LeFort III type); including zygomatic arch and malar tripod; with internal complicated, utilizing internal and/or external fixation fixation and multiple surgical approaches: 21365 techniques (e.g., head cap, halo device, and/or intermaxillary fixation): 21435 Open treatment of complicated (e.g., comminuted or involving cranial nerve foramina) fracture(s) of malar area, Open treatment of craniofacial separation (LeFort III type); including zygomatic arch and malar tripod; with bone grafting complicated, multiple surgical approaches, internal (includes obtaining graft): 21366 fixation, w/ bone grafting (includes obtaining graft): 21436 Open treatment of orbital floor blowout fracture; transantral approach (Caldwell-Luc type operation): 21385 Rhinoplasty Rhinoplasty, primary; lateral and alar and/or Open treatment of orbital floor blowout fracture; periorbital elevation of nasal tip: 30400 approach: 21386 Rhinoplasty, primary; complete, external parts including Open treatment of orbital floor blowout fracture; combined bony pyramid, lateral and alar cartilages, and/or elevation approach: 21387 of nasal tip: 30410

Open treatment of orbital floor blowout fracture; periorbital Rhinoplasty, primary; including major approach, with alloplastic or other implant: 21390 septal repair: 30420

Open treatment of orbital floor blowout fracture; periorbital Rhinoplasty, secondary; minor revision approach with bone graft (includes obtaining graft): 21395 (small amount of nasal tip work): 30430

Closed treatment of fracture of orbit, except blowout; without manipulation: 21400 Rhinoplasty, secondary; intermediate revision (bony work with osteotomies): 30435

15 Rhinoplasty, secondary; major revision (nasal tip work and osteotomies): 30450

Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip only: 30460

Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip, septum, osteotomies: 30462

Repair of nasal vestibule stenosis 30465

16