| Clinical Indicators
Ethmoidectomy
| Procedure |
CPT |
FUD |
| Ethmoidectomy, intranasal, anterior |
31200 |
90 |
| Ethmoidectomy, intranasal, total |
31201 |
90 |
| Ethmoidectomy, extranasal, total |
31205 |
90 |
| Sinusotomy combined (3 or more) |
31090 |
90 |
| Nasal/sinus endoscopy, with partial
ethmoidecomy |
31254 |
0 |
| Nasal endoscopy, with total ethmoidectomy |
31255 |
0 |
| Nasal/sinus endoscopy, surgical; with repair of
cerebrospinal fluid leak; ethmoid region |
31290 |
10 |
| Nasal/sinus endoscopy, surgical; with medial or
inferior orbital wall decompression |
31292 |
10 |
| Nasal/sinus endoscopy, surgical; with medial and
inferior orbital wall decompression |
31293 |
10 |
Nasal/sinus endoscopy, surgical; with
optic nerve decompression |
31294 |
10 |
Indications
1. History... one or more required
| a) |
Failure of medical management (describe) for acute or chronic
ethmoid sinusitis. |
| b) |
Orbital or cranial extension of ethmoiditis. |
| c) |
Ethmoid enlargement (polyp or tumor) causing nasal
obstruction. |
| d) |
Multiple or recurrent nasal polyps causing
obstruction. |
| e) |
Impaired sense of smell. |
2. Physical Examination
| a) |
Description of complete anterior and posterior (if possible)
nasal exam required. |
3. Tests
| a) |
Sinus imaging--describe...required. |
| b) |
Culture and sensitivity--optional, describe results. |
| c) |
Endoscopy. |
Postoperative Observations
| 1. |
Bleeding, eyelid ecchymosis--how managed? Surgeon
notified? |
| 2. |
Pain--severe headache; notify physician. |
| 3. |
Packing--is it in desired location? |
| 4. |
Vision--if there is loss or double vision, notify surgeon
immediately. |
| 5. |
Swelling--is there evidence of facial edema? If hematoma, how
managed? Surgeon notified? |
| 6. |
Mental status-is patient alert and oriented? |
Outcome Review
1. One Week
| a) |
Healing--Did patient require treatment for bleeding or
infection? Is site healing satisfactorily? |
| b) |
Pathology--Does the pathology report indicate need for further
treatment and if so, how managed? |
| c) |
Are there any indicators for CSF rhinorrhea? |
2.Beyond One Month
| a) |
Presenting problem--Is it (see history) improved? |
| b) |
Airway--Is there evidence of airway obstruction due to polyps
or nasal crusting? |
| c) |
Are there any indicators for CSF rhinorrhea? |
Associated ICD-9 Diagnostic Codes
| 212.0 |
Benign neoplasm of nasal cavities, middle ear, and
accessory sinuses |
| 461.2 |
Acute ethmoid sinusitis |
| 471.8 |
Other polyp of sinus |
| 473.2 |
Chronic ethmoidal sinusitis |
| 160.3 |
Ethmoid sinus neoplasm, malignant, primary |
| 197.3 |
Ethmoid sinus neoplasm, malignant, secondary |
| 231.8 |
Ethmoid sinus neoplasm, Ca in situ |
| 235.9 |
Ethmoid sinus neoplasm, uncertain behavior |
| 239.1 |
Ethmoid sinus neoplasm, unspecified |
| 170.0 |
Ethmoid bone or labyrinth neoplasm, malignant,
primary |
| 198.5 |
Ethmoid bone or labyrinth neoplasm, malignant,
secondary |
| 213.0 |
Ethmoid bone or labyrinth neoplasm, benign |
| 238.0 |
Ethmoid bone or labyrinth neoplasm, uncertain
behavior |
| 239.2 |
Ethmoid bone or labyrinth neoplasm,
unspecified |
| 478.1 |
Nasal airway obstruction |
Additional Information
Assistant Surgeon -- N
Supply Charges -- N
Prior Approval -- N
Anesthesia Code(s)
00160
Patient Information
Ethmoidectomy is performed through either an external (facial), transantral
(maxillary sinus), or intranasal (endoscopic) approach. The decision regarding
the best approach to the ethmoid sinus depends on certain technical
considerations best decided by the surgeon. This surgery is per- formed only
after it has been determined that medical management has been unsuccessful.
Surgery, medical management, and failure to treat ethmoid disease all have
similar risks. They include orbital complications (visual impairment),
intra-cranial extension (brain damage or infection), persistent or recurrent
nasal obstruction due to failure to manage polyps, and recurrent nasal
infections.
Important Notice
The Clinical Indicators for Otolaryngology--Head and Neck Surgery
are guidelines only. In no sense do they represent a standard of care. The
applicability of an indicator for a procedure, and/or of the process or outcome
criteria, must be determined by the responsible physician in light of all the
circumstances presented by the individual patient. Adherence to these
guidelines will not ensure successful treatment in every situation. The
American Academy of Otolaryngology-Head and Neck Surgery, Inc. emphasizes that
these clinical indicators should not be deemed inclusive of all proper
treatment decisions or methods of care, nor exclusive of other treatment
decisions or methods of care reasonably directed to obtaining the same
results.
© 2000 American Academy of Otolaryngology-Head and Neck Surgery. One
Prince Street, Alexandria, VA 22314.
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