Case Log Coding Guidelines Review Committee for Otolaryngology ACGME

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The following Case Log Coding Guidelines 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 that was utilized in the development of these guidelines, and the University of Michigan program for the most recent revisions.

Please note that these guidelines additionally provide role definitions for Resident Surgeon, 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 Review Committee to be representative of otolaryngology surgical education. 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 ACGME e-Communication or other correspondence.

GENERAL/ENDOSCOPY/RHINOLOGY ...... 2 Emergency Department Procedures ...... 2 Post-operative Complications ...... 3 Endoscopy: Airway and Foreign Body Procedures ...... 3 Sinus Surgery ...... 3 General/Pediatric ...... 4 PEDIATRIC OTOLARYNGOLOGY ...... 4 LARYNGOLOGY ...... 4 HEAD and NECK SURGERY ...... 5 Endocrine Surgery ...... 5 Neck Dissection ...... 5 Salivary Gland Procedures ...... 5 Oral Cavity/Oropharynx ...... 5 Laryngectomy ...... 6 Anterior Craniofacial Resection ...... 6 Maxillectomy ...... 6 Excision of Cutaneous Facial Lesion ...... 6 Head and Neck Ablative Procedures ...... 6 FACIAL PLASCTIC AND RECONSTRUCTIVE SURGERY ...... 7 Free/Pedicled Flaps ...... 7 Plastics/Trauma Procedures ...... 7 Microtia Repair ...... 8 OTOLOGY/NEUROTOLOGY ...... 9 Otology ...... 9 Ablative Otologic Procedures ...... 9 Reconstructive Otologic Procedures ...... 9 Appendix: Key Indicator Categories ...... 10 laceration repair: *Asterisk by key indicator cases <1.0 cm: 13150 Rules for unbundling noted in blue 1.1-2.5 cm: 13151 2.6-7.5 cm: 13152 Role Definitions: Each additional 5cm Resident surgeon: performs ≥ 50% of the operation (code separate): 13153 with the attending physician or resident supervisor, Open repair frontal sinus fracture: including the key portions of the procedure Depressed: 21343 Resident assistant: performs < 50% of the operation, Complicated: 21344 or ≥ 50% of the operation but not the key portions of Oral vestibule laceration repair: the procedure. ≤2.5cm: 40830 Resident supervisor: instructs/assists a more junior >2.5cm: 40831 resident during a procedure in which the junior FOM/Oral tongue laceration repair: resident performs ≥ 50% of the operation, including the ≤2.5cm: 41250 key portions of the procedure; the attending physician >2.5cm 41252 acts as an assistant or observer. Flexible laryngoscopy, diagnostic: 31575 Flexible laryngoscopy, w/biopsy: 31576 GENERAL/ENDOSCOPY/RHINOLOGY *Flexible laryngoscopy, FB removal: 31577 * Flexible laryngoscopy, lesion removal: 31577 Emergency Department Procedures: Peritonsillar abscess drainage: 42700 Repair complex scalp laceration: Removal impacted cerumen: 69210 1.1-2.5cm: 13120 Removal foreign body from ear: 69200 2.6-7.5cm: 13121 Under GA (operative): 69205 Each additional 5cm Removal of foreign body from nose: 30300 (code separate): 13122 Under GA (operative): 30310 Repair complex forehead/face laceration: 1.1-2.5cm: 13131 Epistaxis Control 2.6-7.5cm: 13132 Anterior epistaxis control (simple): 30901 Each additional 5cm Anterior epistaxis control (complex): 30903 (code separate): 13133 Posterior packing placement: 30905 Repair complex eyelid/ear/nose or lip Revision posterior packing: 30906 2 ©2012 Accreditation Council for Graduate Medical Education (ACGME) Ethmoid artery ligation: 30915 *Bronchoscopy w/FB removal: 31635 Internal maxillary ligation, transantral: 30920 DL w open reduction of fracture: 31584 Endoscopic control, operative: 31238 *DL with dilation, initial: 31528 Septal hematoma/abscess drainage: 30000 *subsequent: 31529 Auricle hematoma/abscess: 69000 *Bronchoscopy w/dilation: 31630 Oral vestibule drainage of cyst, abscess, *Bronchoscopy w/stent placement: 31631 hematoma: *Revision 31638 Simple: 40800 *Bronchoscopy w/tumor excision: 31640 Complicated 40801 *Bronchoscopy w/tumor or stenosis Intraoral I&D abscess/cyst/hematoma: laser ablation: 31641 Lingual: 41000 *Tracheobronchoscopy through Sublingual; superficial: 41005 tracheostomy incision: 31615 Sublingual; deep: 41006 Esophagoscopy, diagnostic: 43200 Submental: 41007 Esophagoscopy, Submandibular space: 41008 w/submucosal injection: 43201 Sublingual/Submaxillary: 42310 w/biopsy: 43202 Masticator space: 41009 w/tumor removal 43217 Extraoral I&D abscess/cyst/hematoma: w/insertion of stent/tube 43219 Sublingual: 41015 w/dilation over guidewire 43226 Submental: 41016 Esophageal dilation Submandibular space: 41017 w/balloon 43220 Masticator space: 41018 w/bougie: 43450 Parotid abscess I&D; simple: 42300 over guidewire: 43453 Parotid abscess I&D; complicated: 42305 retrograde: 45456 Retropharyngeal/parapharyngeal PEG/ G-tube placement: 43246 abscess I&D; intraoral: 42720 Nasopharyngeal biopsy: 42806 Retropharyngeal/parapharyngeal Zenker’s: abscess I&D; extraoral: 42725 (endoscopic) 43499 (open) 43130 Post-operative Complications: (open cricopharyngeal- Neck exploration for hematoma: 35800 myotomy) 43030 Post-operative tonsil bleed requiring OR: 42962 Transcervical repair of esophageal I&D superficial abscess: 10060 wound/injury (open): 43410 I&D deep space hematoma or abscess: 21501 Sinus Surgery (log each side separately): Endoscopy: Airway/Foreign Body Procedures: Insertion of nasal button: 30220 DL, diagnostic: 31525 Removal of FB; lateral rhinotomy: 30320 DL w/biopsy: 31535 Lysis of intranasal synechiae: 30560 DL w/arytenoidectomy: 31560 Endo maxillary antrostomy: 31256 MicroDL w/arytenoidectomy: 31561 Endo maxillary antrostomy + tissue: 31267 Tracheoscopy or microlaryngoscopy Endo frontal +/- tissue: 31276 with biopsy: 31536 Endo sphenoid: 31287 *Bronchoscopy, diagnostic: 31622 Endo sphenoid + tissue: 31288 *Bronchoscopy with BAL: 31624 Endo biopsy or polyp or debridement: 31237 *Bronchoscopy with biopsy: 31625 Endo concha bullosa: 31240 Awake fiberoptic intubation or DCR: emergency intubation: 31500 Endo 31239 Cricoidotomy: 31605 Open/fistulization 68720 Tracheotomy, planned: 31600 *Endo Ant ethmoid: 31254 Tracheotomy, emergency: 31603 *Endo total ethmoid: 31255 Tracheal repair: 31800 Endo diag., maxillary b inf meatus: 31233 *DL with FB removal: 31530 Endo nasal: 31231 Micro DL, diagnostic: 31526 Endo CSF leak repair: *Micro DL w/FB removal: 31531 Ethmoid region: 31290 Removal FB pharynx: 42809 Sphenoid region: 31291 Esophagoscopy w/FB removal: 43215 CSF leak repair w/graft: 61618

3 ©2012 Accreditation Council for Graduate Medical Education (ACGME) (code graft harvest separately) Tonsil alone Endo orbital wall decompression: > 12yrs: 42826 Medial or inferior wall: 31292 <12 yrs: 42825 Medial and Inferior wall: 31293 Adenoid alone: Endo optic nerve decompression: 31294 > 12yrs: 42831 <12yrs: 42830 Non-Endoscopic Sinus Surgery: M&T: Sinusotomy; frontal: Myringotomy 69420 Trephine: 31070 Myringotomy under GA 69421 Transorbital: 31075 Tube 69433 Frontal sinusotomy; obliterative: Tube under GA 69436 Brow incision w/o osteoplastic flap: 31080 Removal of ear tube under GA: 69424 Coronal incision w/o osteoplastic flap: 31081 Brow incision w/osteoplastic flap: 31084 PEDIATRIC OTOLARYNGOLOGY Coronal incision w/osteoplastic flap: 31085 Pediatric Airway and Neck: Frontal sinusotomy; non-obliterative: See also above codes for “Endoscopy: Airway and Brow incision w/osteoplastic flap: 31086 Foreign Body” Coronal incision w/osteoplastic flap: 31087 DL / tracheoscopy in pediatric patients: 31536 Lavage by canulation; maxillary: 31000 MicroDL/Supraglottoplasty: 31541 Lavage by canulation; sphenoid: 31002 *Diagnostic DL of newborn: 31520 Sinusotomy; maxillary antrostomy: 31020 *Tracheotomy = <2y: 31601 Sinusotomy; Caldwell-Luc: 31030 *Cricoid split: 31587 Sinusotomy; Caldwell-Luc + polyps: 31032 *Laryngoplasty for web; 2 stage w/keel Sinusotomy: sphenoid+/- biopsy: 31050 insertion or removal: 31580 Sinusotomy: sphenoid + polypectomy: 31051 *LTR: 31582 Ethmoidectomy; intranasal, anterior: 31200 -Rib graft: 20910 Ethmoidectomy; intranasal, total: 31201 CTR / Trach R+R: 31780 Ethmoidectomy; extranasal, total: 31205 *Laryngoplasty, NOS 31588 *Resection nasal dermoid: General/Pediatric: *simple 30124 Intranasal biopsy: 30100 *complex 30125 Transnasal excision nasal polyp: *Excision of vascular anomaly; Simple: 30110 *w/o deep neurovascular dissection: 38550 Extensive: 30115 *w/deep neurovascular dissection: 38555 Excision of intranasal lesion: *Branchial cleft anomaly not cyst: 42810 Internal: 30117 *Branchial cleft cyst: 42815 Lateral rhinotomy: 30118 *Thyroglossal duct cyst: 60280 Turbinate soft tissue ablation; *recurrent 60281 Mucosal, any method: 30801 Choanal atresia repair: Submucosal, any method: 30802 Intranasal: 30540 Turbinate excision, any method: 30130 transpalatine: 30545 Fracture inferior turbinate: 30930 Drainage of RP or PPS abscess Turbinate, submucous resection: 30140 internal approach: 42720 Turbinate injection: 30200 external approach: 42725 Septoplasty: 30520 Tongue fixation to lip for micrognathia: 41510 Frenotomy: 41010 Frenuplasty; revision w/Z-plasty: 41520 LARYNGOLOGY UPPP: 42145 Tongue base suspension: 41512 DL w/ tumor excision or stripping vocal Uvulectomy: 42140 cord or epiglottis: 31540 Chemical or thermal destruction of *MicroDL w/arytenoidectomy: 31561 palate 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

4 ©2012 Accreditation Council for Graduate Medical Education (ACGME) mass w/graft recon: 31546 Resection parapharyngeal space tumor: 61605 *SML w/cordectomy: 31370 Vessel exploration: 35701 *SML w/endoscopic hemi laryngectomy: Major vessel repair: 35201 antero-vertical: 31380 latero-vertical: 31375 Salivary Gland Procedures: antero-latero-vertical: 31382 *Superficial parotid w/FN dissection: 42415 VF injection/injection laryngoplasty: 31570 *Superficial parotid w/o FN dissection: 42410 VF injection or injection laryngoplasty *Total parotid with FN dissection: 42420 (with microsope/telescope): 31571 *Total parotid with FN sacrifice: 42425 *Medialization thyroplasty: 31588 -If you graft the FN: 64885 Triple procedure: If you do a parotid/neck, log one of the above codes Adduction arytenopexy: 31400 and log the neck procedure separately Medialization thyroplasty: 31588 If mass goes into parapharyngeal space, Cricothyroid subluxation: 31599 also log: 61590 Office-based PDL: 31578 If abdominal fat graft following parotid: 20926 Office-based injection laryngoplasty: 31513 Submandibular gland excision: 42440 Stroboscopy: 31579 Selective neck dissection (levels 1A-1B):38724 Laryngeal EMG: 95865 Sublingual gland excision: 42450 *DL w/insertion of obturator: 31527 Ranula: *DL w/dilation, initial: 31528 Excision: 42408 *DL w/ dilation, subsequent: 31529 Marsupialization: 42409 Closure salivary fistula: 42600 HEAD AND NECK SURGERY Dilation salivary duct: 42650 Dilation of salivary duct w/catheter: 42660 Endocrine Surgery: Ligation salivary duct; intraoral: 42665 *Hemithyroidectomy: 60220 Sialodochoplasty; *Hemithyroid; partial contralateral: 60225 Primary or simple: 42500 *Completion thyroidectomy: 60260 Secondary or complicated: 42505 *Total thyroidectomy: 60240 Parotid duct diversion: 42507 *Total thyroidectomy w/pre-tracheal/ prelaryngeal dissection: 60252 Lip/Oral Cavity/Oropharynx: *Total thyroidectomy w/radical neck Lip Biopsy: 40490 dissection: 60254 Vermillionectomy w/advancement flap: 40500 *Completion total thyroidectomy: 60260 Wedge excision; primary closure: 40520 Code neck dissection separately. Thyroid case in Lip excision; >1/4 of lip: 40530 which attending does most of the first lobe and you are Lip excision; local flap repair: 40525 surgeon on the other side: (Log two different case IDs Lip excision; cross lip repair: 40527 for each hemi thyroid - one as resident assistant and OC FB removal (embedded): one as resident surgeon) Simple: 40804 *Parathyroid auto-transplantation: 60512 Complicated: 40805 *Parathyroidectomy: 60500 Biopsy of oral tongue: 41100 *Parathyroidectomy; re-exploration: 60500 Glossectomy to be coded without neck dissection to keep unbundled: Neck Dissection (log each side separately): *Partial glossectomy w/o primary *MRND/SLND/SOHND: 38724 closure: 41120 *Radical ND: 38720 *Hemiglossectomy w/o primary Submandibular gland excision: 42440 closure: 41130 Deep cervical node biopsy/SLNB: 38510 *Total glossectomy: 41140 Dissection, jugular node(s): 38542 Excision of oral tongue lesion without If you get into IJ/carotid and repair it: 35201 closure 41110 Excision soft tissue mass, neck: 21555 Excision tongue lesion w/primary closure: 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

5 ©2012 Accreditation Council for Graduate Medical Education (ACGME) *Resection of RMT or OP tumor 42844 parapharyngeal space or middle *Excision mandible tumor: 21045 cranial fossa: 61590 Log neck dissection or tracheostomy separately if Infratemporal resection of tumor/mass: 61605 jointly performed with oral cavity/OP resection Transpetrous approach to skull base: 61598 Tooth extraction: 41823 Resection of midline skull base Oroantral fistula repair: tumor/mass: 61607 Oromaxillary: 30580 Oronasal: 30600 If you put in a flap, code as under free/pedicled flaps Limited Pharygectomy: 42890 category

Laryngectomy: Maxillectomy: Laryngectomy (without neck dissection to keep Maxillectomy unbundled): 31360 (including total, inferior, or medial): 31225 Hemilaryngectomy (horizontal): 31370 If you take the eye: 65110 Hemilaryngectomy (laterovertical): 31375 Placement of pin-borne prosthesis: 42281 Hemilaryngectomy (anterovertical): 31380 Hemilaryngectomy (anterolaterovertical):31382 Excision of cutaneous facial lesion: Epiglotidectomy: 31420 Malignant face/eyelid/nose lesion Pharyngectomy: <0.5 cm: 11640 (when closed primarily) 42892 0.6-1.0 cm: 11641 (if requires flap for closure) 42894 1.1-2.0 cm: 11642 Unbundle for laryngopharyngectomy 2.1-3.0 cm: 11643 Supraglottic laryngectomy: 31367 3.1-4.0 cm: 11644 -If you close the pharynx primarily >4.0 cm: 11646 (pharyngoesophageal repair): 42953 Benign face/eyelid/nose lesion -*If you take total thyroid: 60240 <0.5 cm: 11440 -*If you take hemithyroid: 60225 0.6-1.0 cm: 11441 -*If you do MRND or SLND: 38724 1.1-2.0 cm: 11442 -*If you do radical ND: 38720 2.1-3.0 cm: 11443 -*If you do rotational SCM flap: 15732 3.1-4.0 cm: 11444 -*If you assist in PIG >4.0 cm: 11446 (pharyngeal interposition graft): 15758 Malignant Scalp/Neck Lesion TEP and prosthesis: 31611 <0.5 cm: 11620 Laryngofissue: 0.6-1.0 cm: 11621 w/tumor/laryngocele excision: 31300 1.1-2.0 cm: 11622 diagnostic: 31320 2.1-3.0 cm: 11623 Cricopharyngeal myotomy: 43030 3.1-4.0 cm: 11624 >4.0 cm: 11626 Anterior Craniofacial Resection: Benign Scalp/Neck Lesion Pterygomaxillary fossa surgery; <0.5 cm: 11420 any approach: 31040 0.6-1.0 cm: 11421 Anterior craniofacial approach 1.1-2.0 cm: 11422 and tumor resection w/o anterior 2.1-3.0 cm: 11423 cranial fossa resection: 61580 3.1-4.0 cm: 11424 Anterior craniofacial approach >4.0 cm: 11426 and tumor resection w/anterior Sentinel lymph node Box/Exec: 38510 cranial fossa resection: 61582 If you inject ethylene blue dye, add: 38792 Orbitocranial approach to ant cranial fossa (ACF): 61584 Head and Neck Ablative Procedures: Bicoronal, transzygomatic or LeFort I Diagnostic DL: 31525 osteotomy approach to ACF: 61586 DL w/biopsy: 31535 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

6 ©2012 Accreditation Council for Graduate Medical Education (ACGME) *Excision of FOM lesion: 41116 1.1-2.5cm: 13131 *Partial glossectomy: 41120 2.6-7.5cm: 13132 *Hemiglossectomy: 41130 Each additional 5cm *Composite resection of tongue/FOM/mandible (code separate): 13133 (unbundle from neck): 41150 Repair complex eyelid/ear/nose or lip *Mandible excision for: laceration repair: *ORN/benign tumor/cyst: 21047 <1.0 cm: 13150 *Malignant tumor: 21044 1.1-2.5 cm: 13151 *Segmental mandibulectomy: 21045 2.6-7.5 cm: 13152 Auriculectomy; complete: 69120 Each additional 5cm Auriculectomy; partial: 69110 (code separate): 13153 Carotid body tumor excisions: Open repair frontal sinus fracture: Carotid sparing: 60600 Depressed: 21343 Carotid sacrifice: 60605 Complicated: 21344 Closed reduction of nasal fracture: FACIAL PLASTIC AND RECONSTRUCTIVE Without stabilization: 21315 SURGERY With stabilization: 21320 *Open reduction of nasal fracture: Free/Pedicled Flaps: (log this as closed rhinoplasty *RFFF (log assist if you help with inset): 15758 with bony work:) 30435 *FFF (log assist if you help with inset): 20969 *ZMC/midface fracture: 21360 *ALT (log assist if you help with inset): 15756 (If done with Ophth, log orbital fx *Pec Flap: 15734 as assist: 21390 *TPFF, or temporalis muscle flap, or and log canthotomy if done: 67715 SCM rotational flap: 15732 *Closed alveolar fracture repair: 21440 *Cervico-facial rotational/advancement flap: *Open alveolar fracture repair: 21445 if <10 cm2: 14060 *Percutaneous mandibular fracture if 10-30 cm2: 14061 repair; external fixation: 21452 if > 30cm2: 14300 *Open mandibular fracture repair; *Paramedian forehead flap: 15731 external fixation: 21454 *Takedown of paramedian forehead flap *Mandible fracture: pedicle (2nd stage) 15630 (Log each aspect of case separately) Free flap +/- vessel anastomosis: MMF: 21453 *Muscle or myocutaneous: 15756 ORIF mandible fx: 21462 *Cutaneous: 15757 OR w/o fixation: 21461 *Fascia: 15758 *Open condylar fracture repair: 21465 *Osteocutaneous: 20969 *LeFort I fracture: *Iliac crest: 20970 Closed repair: 21421 If you scrub in only to close: Simple open repair: 21422 -Close the arm: Complex open repair: 21423 skin graft: 15100 *LeFort II fracture: arm wound: 12035 Closed repair: 21345 -*Advancement closure of leg Simple open repair: 21346 (i.e.,: fibula, ALT): 14021 Complex open repair: 21347 -Close the chest (pec): 14001 *LeFort III fracture: -Close the neck: 12046 Closed repair: 21431 -Close the parotid: 12055 Simple open repair: 21432 Facial-hypoglossal nerve repair: 64868 Complex open repair: 21433 *Percutaneous malar/tripod fx repair: 21355 Plastics/Trauma Procedures: *Gilles approach to zygomatic arch fx: 21356 Repair complex scalp laceration: *Open zygomatic arch/tripod fx repair: 21365 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 rhinoplasty:

7 ©2012 Accreditation Council for Graduate Medical Education (ACGME) Septoplasty: 30520 Temporalis tendon transfer: 15845 *Rhinoplasty: 30410 Neurorrhaphy: 64868 *Revision rhinoplasty: 30450 Nerve graft harvest: *Nasal valve repair: 30465 ≤4cm graft: 64885 *Repair of nasal vestibule stenosis 30465 >4cm graft: 64886 Cartilage graft: Fascia lata graft: 20922 Septal cartilage graft: 20912 Costochondral: 20910 STSG to face Bone graft: (eyelids, nose, mouth, lips, ears,neck): 15120 Small or minor: 20900 Dermal graft; face or neck: 15135 Large or major: 20902 Derma-fat-fascia graft: 15770 Facial bone graft: 21210 *FTSG Cleft lip repair: (including closure of donor site, scalp, arms or legs): Primary: 40700 ≤ 20cm2: 15220 Secondary: 40720 2 Cleft palate repair: ≥ 20cm or part thereof: 15221 Palatoplasty: 42200 *FTSG Palatoplasty w/alveolar ridge: 42210 (including closure of donor site forehead, Major revision: 42215 cheeks, chin, mouth, neck): Palatoplasty w/pharyngeal flap: 42225 ≤ 20cm2: 15240 Palatoplasty w/island flap: 42227 ≥ 20cm2 or part thereof: 15241 Rhytidectomy; forehead: 15824 *FTSG Rhytidectomy: 15828 (including closure of donor site to nose, ears, Rhytidectomy SMAS flap: 15829 eyelids): Platysmectomy (platysmal tightening): 15825 2 Cervicoplasty: 15819 ≤ 20cm : 15260 Facial plastics Botox inj. (not larynx) 96372 ≥ 20cm2 or part thereof: 15261 Blepharoplasty: *Composite Graft (i.e.,: full-thickness of (Log each eye and each site {upper or lower} external ear or including primary closure separately) of donor site) 15760 Upper blepharoplasty: 15823 Acellular dermal replacement: 15175 Lower blepharoplasty: 15821 *Autologous Ear cartilage graft Repair of blepharoptosis: (to nose or ear): 21235 Frontalis muscle pexy: 67901 Liposuction of head and neck: 15876 Levator resection/advancement: 67904 Adjacent tissue transfer/rearrangement: Sup. rectus technique: 67906 Scalp; ≤10 sq cm: 14020 Fasanella-Servat technique: 67908 Revision for overcorrection: 67909 Scalp; >10 sq cm: 14021 Correction of lid retraction: 67911 Any site >30 sq cm: 14300 Ectropion repair; *Paramedian forehead flap: 15731 Suture: 67914 *Takedown paramedian forehead flap: 15730 Cautery: 67915 Moh’s reconstruction (tissue rearrangement, Excision tarsal wedge: 67916 advancement, rotational flaps): Tarsal strip: 67917 *eyelids, nose, ear, lips Canthoplasty: 67950 <10 sq cm: 14060 Otoplasty (protruding ear): 69300 10-30 sq cm: 14061 Brow lift (any approach): 67900 *forehead, cheek, chin, mouth, lips Eyelid weight: 67912 <10 cm2: 14040 Removal of eyelid weight: 67912 10-30 cm2: 14041 Vestibuloplasty: *takedown of melolabial flap pedicle: 15630 Anterior: 40840 Scar contracture release: 15003 Posterior: 40840 Microtia repair: Entire arch: 40844 st Complex 40845 1 stage with rib graft: 21230 *2nd stage lobule transposition: 14061 Gracilis free flap: Unbundle as appropriate rd Myogenous free flap for paralyzed face: 15842 *3 stage elevation of auricle w/STSG: 14061

8 ©2012 Accreditation Council for Graduate Medical Education (ACGME) STSG (code separately): 15120 CPA tumor: Dermabrasion: 15781 Suboccipital/Retrosig: 61520 Chemical peel: 15788 *Translabyrinthine approach: 61596 *Middle cranial fossa approach: 61530 OTOLOGY/NEUROTOLOGY Resection of petrous apex lesion: Extradural: 61605 Otology: Intradural: 61606 *Stapes 69660 Vestibular nerve section: *Revision Stapes: 69662 Translabyrinthine approach: 69915 *Stapes mobilization: 69650 Transcranial approach: 69950 ME Exploration (postauric or transcanal):69440 Endolymphatic sac decompression: Cochlear Implant (two codes): w/shunt: 69805 Insertion: 69930 w/o shunt: 69806 *Mastoidectomy: 69502 Labyrinthectomy: 69910 Replace BAHA: 69717 Implant BAHA: 69714 Reconstructive otologic procedures: with STSG: 15120 Meatoplasty: 69310 Facial nerve decompression; partial: 69720 STSG: 15120 *Facial nerve decompression; total: 69955 *Myringoplasty: 69620 Suture repair of intramastoid CN VII: 69740 Exostoses/Canalplasty: 69140 (code decompression/mastoid and nerve graft harvest Canalplasty for atresia: 69320 separately) *Tymp without OCR: 69631 Endolymphatic sac decomps + shunts (two codes): *Tymp with OCR: Sac Decompression: 69806 autologous tissue 69632 *Mastoidectomy: 69502 TORP or PORP 69633 Glomus tumor excision: *Tymp with mastoid and OCR: 69642 Transcanal: 69550 (code tymp/OCR and mastoid separate) Transmastoid: 69552 CSF leak dura repair w/graft: 61618 Extended (extratemporal): 69554 (code graft separately) (code neck approach separately) Eust Tube Catheter, transnasal: 69400 The following appendix contains Ablative Otologic Procedures: *** need to unbundle and log separately the 14 current key indicator case tympanoplasty, mastoidectomy, and/or OCR from categories and the complete list of a key indicator case recording standpoint constituent key indicator case

*Simple mastoid: 69501 codes *Complete mastoid (CWU): 69502 *MR Mastoid (CWD stapes +/-malleus, incus intact): 69505 *Radical mastoid (CWD all ossicles taken): 69511 Mastoid bowl debridement; complex: 69222 *Petrous apicectomy: 69530 *Revise mastoid to complete: 69601 *Revise mastoid to Mod rad: 69602 *Revise mastoid to Rad: 69603 *Mastoid obliteration: 69670 Lateral TB resection: 69535 Excision of EAC lesion: 69145 Radical excision EAC lesion: 69150 *Radical excision EAC lesion + neck dissection: 69155 (code neck dissection separately) Auriculectomy: 69120

9 ©2012 Accreditation Council for Graduate Medical Education (ACGME) 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 bronchography

(fiberscope 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 bronchus: 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

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 burns, 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 autotransplantation: 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 ©2012 Accreditation Council for Graduate Medical Education (ACGME) 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 ©2012 Accreditation Council for Graduate Medical Education (ACGME) (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 ©2012 Accreditation Council for Graduate Medical Education (ACGME) 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/Maxilla 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: 21454 feet: 15620 Open treatment of mandibular fracture; without interdental Delay of flap or sectioning of flap (division and inset); at fixation: 21461 eyelids, nose, ears, or lips: 15630

14 ©2012 Accreditation Council for Graduate Medical Education (ACGME) Open treatment of mandibular fracture; with interdental Closed treatment of fracture of orbit, 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 cartilages 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

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