OTOLARYNGOLOGY-HEAD AND NECK SURGERY PROCEDURE BUNDLES / CPT

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1 OTOLARYNGOLOGY-HEAD AND NECK SURGERY PROCEDURE BUNDLES / CPT LEVEL I CORE PRIVILEGES CPT EVALUATION & CLINICAL CARE Admit, Consult, H&P, Orders. Laryngoscopy Esophagoscopy Bronchoscopy Nasendoscopy Examination Under Anesthesia Incisional and Debridement Remove Foreign Body Drainage Hematoma, Seroma Debridement Skin or Wound Repair Laceration in Layers Biopsy Lesion (Shave, Punch, Incisional, Excisional) Incisional Biopsy, Malignant Lesion Biopsy Lymph Node ENDOSCOPY Laryngoscopy - Laser Bronchoscopy - Laser Nasendoscopy-Laser Endoscopic Creation of Speaking Tracheo-Esophageal Fistula FACIAL FRACTURES/CRANIOMAXILLOFACIAL Reduction of Nasal Fracture - Closed Reduction of Nasal Fracture - Open Placement of Arch Bars - With or Without IMF Removal of Arch Bars Reduction of Mandibular Fracture - Closed Reduction of Mandibular Fracture - Open Reduction of Zygomatic Fracture Reduction of Malar Complex (Trimalar) Fracture Orbital Floor Exploration Reduction of Nasoethmoid Fracture Reduction of Complex Maxillary Fracture (Le Fort 1) Reduction of Complex Maxillary Fracture (Le Fort 2) Reduction of Complex Maxillary Fracture (Le Fort 3) Bone or Cartilage Graft Genioplasty (Not Cosmetic) Chin Implant Facial Injection or Grafting Facial Osteotomy / Genioplasty Malar Implant Malar Implant with Bone Graft Use Mandibular Implant Correction Orbital Floor Fracture Reduction Frontal Bone Fracture Reduction Complex Facial Fractures Maxillary Fracture (Open or Closed) Placement Synthetic Material OF 6

2 GRAFTS / FLAPS Split Thickness Skin Graft 15120_3 Full Thickness Skin Graft 15135_3 Dermal Graft Cartilage Graft Bone Graft Local Skin Flap Reconstruction Lip Flap Reconstruction Pectoralis Myocutaneous Flap Deltopectoral Flap Forehead and/or Scalp Pedicle Flap Trapezius Myocutaneous Flap Facial Sling Latisimus LARYNX / TRACHEA Tracheostomy Laryngofissure Thyrotomy Arytenoidectomy Cordectomy Supraglottic Laryngectomy Hemilaryngectomy Total Laryngectomy Exploration and/or Repair of Laryngeal Fractures NECK Incision & Drainage of Neck Abscess Neck Exploration Excision of Thyroglossal Duct Cyst Excision of Branchial Cleft Cyst Excision of Carotid Body Tumor Excision of Other Neck Lesion Cervical Node Biopsy Radical Neck Dissection Modified Radical Neck Dissection Selective Neck Dissection Supraomohyoid Neck Dissection Thyroid Lobectomy Thyroid Lobectomy With Isthmusectomy Subtotal Thyroidectomy Total Thyroidectomy Parathyroidectomy Reimplantation of Parathyroid Ligation of Major Vessel Diverticulectomy Cricopharyngeal Myotomy Superficial Parotidectomy Total Parotidectomy Submandibular Gland Excision Incision & Drainage of Salivary Gland Abscess OF 6

3 NOSE / MAXILLA / SINUS Foreign Body Removal from the Nose Excision of Intranasal Tumor Nasal Polypectomy Septoplasty Septoplasty / rhinoplasty Lateral Rhinotomy Medial Maxillectomy Radical Maxillectomy Orbital Exenteration 65110_3 Dacrocystorhinostomy 68720_3 Partial Rhinectomy Total Rhinectomy Turbinate Reduction Nasal Reconstructon Antrotomy With or Without Lavage Caldwell-Luc Transantral Ligation of Vessels ESS - Ethmoidectomy ESS - Sphenoid Sinusotomy ESS - Antrotomy ESS - Frontal Sinusotomy External Ethmoidectomy Frontoethmoidectomy Frontal Sinus Trephine Osteoplastic Frontal Sinusotomy Frontal Sinus Ablation Orbital Decompression Nasal Reconstruction (Including Septum and External Nose) ORAL CAVITY / PALATE / NASOPHARYNX Tonsillectomy Adenoidectomy Palatopharyngoplasty Palatectomy - Partial or Total Resection of Nasopharyngeal Tumor Partial Glossectomy Total Glossectomy Partial Mandibulectomy Composite Resection Local Excision of Oral Cavity Lesion Laser Excision of Oral Cavity Lesion Excision of Floor of Mouth Oroantral Fistula Repair Choanal Atresia Repair Dental Extraction with Mandibular Fracture Mandibular Reconstruction Excision & Curettage of Mandibular Cyst OF 6

4 OTOLOGIC Myringotomy With or Without Insertion of PET s Tympanoplasty Without Ossiculoplasty Tympanoplasty With Ossiculoplasty Tympanoplasty With Mastoidectomy Cortical Mastoidectomy Modified Radical Mastoidectomy Meatoplasty Excision of External Auditory Canal Tumor Excision of Mastoid Tumor Excision of Middle Ear Tumor Ossicular Reconstruction Auriculectomy Canaloplasty Drainage of Abscess or Hematoma Foreign Body Removal from the Ear Facial Nerve Repair, Graft or Interposition Construction / Reconstruction of Auricle Otoplasty Ear Examination Under Anesthesia COSMETIC Blepharoplasty - Upper 15823_3 Blepharoplasty - Lower 15821_3 Brow Lift 67900_3 Buccal Fat Excision Cheek Lift Chin Implant Facial Injection or Grafting Facial Osteotomy / Genioplasty Liposuction - Face Mandibular Implant Malar Implant Otoplasty Rhinoplasty Rhytidectomy Submental Lipectomy Surgical Treatment of Ear Keloid Temporal Lift Chemical Peel Dermabrasion Laser Resurfacing Scar Revision - Complex Scar revision - Simple Surgical Treatment of Keloid OF 6

5 SKIN AND SOFT TISSUE (SST) Incision & Drainage of Cutaneous Abscess or Hematoma Removal of Foreign Body Debridement of Wound Simple Debridement of Wound Complex Repair of Laceration Simple Repair of Laceration Complex Excision of Lip Lesion Biopsy of Skin Lesion Excision of Benign Skin Lesion Excision of Malignant Skin Lesion Reconstruction of Eyelids Tarrsoraphy Gold Weight Insertion to the Eyelid Lateral Canthopexy Ptosis Repair Filler/Implant Hair Flaps/Grafts Static Procedures for Facial Palsy Scar Revision (Not Cosmetic) Mid-Face Lift (Not Cosmetic) Rhytidectomy (Not Cosmetic) Surgical Treatment of Ear Keloid Repair Soft Tissue Injury Repair Lacrimal Duct Repair Eyelid Laceration Repair Ear Superficial Repair Ear Complex Acute Debridement and Grafting, Burns Late Reconstruction, Burns Scar Revision, Complex Depends on Site Size Scar Revision, Simple Depends on Site Size Surgical Treatment of Keloid Split Thickness Skin Graft Full Thickness Skin Graft Skin and Fascial Flaps Tissue Expansion Excision Benign Lesions, Head and Neck Excision Benign Lesions, Elsewhere Excision Malignant Lesion, Head and Neck Chemical Peel (Not Cosmetic) Dermabrasion (Not Cosmetic) Fat Grafting (Not Cosmetic) LASER CO 2 KTP Erbium Etc ADMINISTRATION OF SEDATION AND ANALGESIA 5 OF 6

6 LEVEL II ADVANCED PRIVILEGES MICROVASCULAR Free Tissue Transfer LARYNX / TRACHEA Denervation of Recurrent Laryngeal Nerve Reinnervation of Recurrent Laryngeal Nerve Laryngoplasty Tracheoplasty Segmental Tracheal Resection OTOLOGIC Stapedectomy Vestibular Nerve Section Acoustic Neuroma Resection CSF Leak Repair Labyrinthectomy Excision of Skull Base Tumor Cochlear Implantation Temporal Bone Resection Facial Nerve Decompression CRANIOMAXILLFACIAL Cleft Lip Repair, Unilateral Cleft Lip Repair, Bilateral Cleft Palate Repair Primary Cleft Lip Rhinoplasty Secondary Repair Cleft Lip Secondary Cleft Lip Rhinoplasty Alveolar Bone Graft Palatal Fistula Repair Pharyngeal Flap or Pharyngoplasty Other Facial Cleft Repair Reconstruction Microtic Ear, 1 st Stage Reconstruction Microtic Ear, Subsequent Stage Correction Eyelid Ptosis Mandibular Osteotomy Placement Mandibular Craniofacial Distraction Device Remove Mandibular Craniofacial Distraction Device Maxillary Osteotomy Placement Maxillary / Craniofacial Distraction Device Remove Maxillary / Craniofacial Distraction Device Major Craniofacial Reconstruction Liposuction for Congenital Asymmetry Dynamic Procedures for Facial Palsy Facial Re-Innervation ROBOTICS (contact Perioperative Services for Robotic Privileging) 6 OF 6