OTOLARYNGOLOGY-HEAD AND NECK SURGERY PROCEDURE BUNDLES / CPT LEVEL I CORE PRIVILEGES CPT EVALUATION & CLINICAL CARE Admit, Consult, H&P, Orders. Laryngoscopy 31505-31579 Esophagoscopy 43200-43232 Bronchoscopy 31622-31656 Nasendoscopy 31231-31294 Examination Under Anesthesia 92502 Incisional and Debridement 10060 Remove Foreign Body 10120 Drainage Hematoma, Seroma 10140 Debridement Skin or Wound 11000 Repair Laceration in Layers 12032 Biopsy Lesion (Shave, Punch, Incisional, Excisional) 11402 Incisional Biopsy, Malignant Lesion 11100 Biopsy Lymph Node 38500 ENDOSCOPY Laryngoscopy - Laser 31545 Bronchoscopy - Laser 31641 Nasendoscopy-Laser Endoscopic Creation of Speaking Tracheo-Esophageal Fistula 31611 FACIAL FRACTURES/CRANIOMAXILLOFACIAL Reduction of Nasal Fracture - Closed 21310 Reduction of Nasal Fracture - Open 21325 Placement of Arch Bars - With or Without IMF 21453 Removal of Arch Bars 20694 Reduction of Mandibular Fracture - Closed 21440 Reduction of Mandibular Fracture - Open 21462 Reduction of Zygomatic Fracture 21356 Reduction of Malar Complex (Trimalar) Fracture 21360 Orbital Floor Exploration 67400 Reduction of Nasoethmoid Fracture 21340 Reduction of Complex Maxillary Fracture (Le Fort 1) 21346 Reduction of Complex Maxillary Fracture (Le Fort 2) 21422 Reduction of Complex Maxillary Fracture (Le Fort 3) 21432 Bone or Cartilage Graft 20902 Genioplasty (Not Cosmetic) 21199 Chin Implant 21120 Facial Injection or Grafting 15770 Facial Osteotomy / Genioplasty 21121 Malar Implant 21270 Malar Implant with Bone Graft Use 21210 Mandibular Implant 21125 Correction Orbital Floor Fracture 21395 Reduction Frontal Bone Fracture 21343 Reduction Complex Facial Fractures 21365 Maxillary Fracture (Open or Closed) 21360 Placement Synthetic Material 11950 1 OF 6
GRAFTS / FLAPS Split Thickness Skin Graft 15120_3 Full Thickness Skin Graft 15135_3 Dermal Graft 15135 Cartilage Graft 21235 Bone Graft 21210 Local Skin Flap Reconstruction 15740 Lip Flap Reconstruction 40527 Pectoralis Myocutaneous Flap 15732 Deltopectoral Flap 15732 Forehead and/or Scalp Pedicle Flap 15630 Trapezius Myocutaneous Flap 15650 Facial Sling 15840 Latisimus LARYNX / TRACHEA Tracheostomy 31600 Laryngofissure Thyrotomy 31300 Arytenoidectomy 31400 Cordectomy 31300 Supraglottic Laryngectomy 31367 Hemilaryngectomy 31370 Total Laryngectomy 31360 Exploration and/or Repair of Laryngeal Fractures 31584 NECK Incision & Drainage of Neck Abscess 21501 Neck Exploration 38542 Excision of Thyroglossal Duct Cyst 60280 Excision of Branchial Cleft Cyst 42815 Excision of Carotid Body Tumor 60600 Excision of Other Neck Lesion 21555 Cervical Node Biopsy 38510 Radical Neck Dissection 38720 Modified Radical Neck Dissection 38724 Selective Neck Dissection 38510 Supraomohyoid Neck Dissection 38700 Thyroid Lobectomy 60220 Thyroid Lobectomy With Isthmusectomy 60210 Subtotal Thyroidectomy 60271 Total Thyroidectomy 60240 Parathyroidectomy 60500 Reimplantation of Parathyroid 60512 Ligation of Major Vessel 37615 Diverticulectomy 43130 Cricopharyngeal Myotomy 43130 Superficial Parotidectomy 42410 Total Parotidectomy 42420 Submandibular Gland Excision 42440 Incision & Drainage of Salivary Gland Abscess 42300 2 OF 6
NOSE / MAXILLA / SINUS Foreign Body Removal from the Nose 30310 Excision of Intranasal Tumor 30117 Nasal Polypectomy 30115 Septoplasty 30520 Septoplasty / rhinoplasty 30420 Lateral Rhinotomy 30118 Medial Maxillectomy 31225 Radical Maxillectomy 31230 Orbital Exenteration 65110_3 Dacrocystorhinostomy 68720_3 Partial Rhinectomy 30150 Total Rhinectomy 30160 Turbinate Reduction 30140 Nasal Reconstructon 30465 Antrotomy With or Without Lavage 31020 Caldwell-Luc 31020 Transantral Ligation of Vessels 30920 ESS - Ethmoidectomy 31255 ESS - Sphenoid Sinusotomy 31287 ESS - Antrotomy 31256 ESS - Frontal Sinusotomy 31276 External Ethmoidectomy 31205 Frontoethmoidectomy 31090 Frontal Sinus Trephine 31070 Osteoplastic Frontal Sinusotomy 31085 Frontal Sinus Ablation 31081 Orbital Decompression 31292 Nasal Reconstruction (Including Septum and External Nose) 30462 ORAL CAVITY / PALATE / NASOPHARYNX Tonsillectomy 42825 Adenoidectomy 42830 Palatopharyngoplasty 42145 Palatectomy - Partial or Total 42120 Resection of Nasopharyngeal Tumor 42804 Partial Glossectomy 41130 Total Glossectomy 41140 Partial Mandibulectomy 21044 Composite Resection 41155 Local Excision of Oral Cavity Lesion 40810 Laser Excision of Oral Cavity Lesion 40820 Excision of Floor of Mouth 41116 Oroantral Fistula Repair 30600 Choanal Atresia Repair 30540 Dental Extraction with Mandibular Fracture 41899 Mandibular Reconstruction 21245 Excision & Curettage of Mandibular Cyst 21040 3 OF 6
OTOLOGIC Myringotomy With or Without Insertion of PET s 69433 Tympanoplasty Without Ossiculoplasty 69643 Tympanoplasty With Ossiculoplasty 69642 Tympanoplasty With Mastoidectomy 69641 Cortical Mastoidectomy 69502 Modified Radical Mastoidectomy 69505 Meatoplasty 69310 Excision of External Auditory Canal Tumor 69145 Excision of Mastoid Tumor 69502 Excision of Middle Ear Tumor 69799 Ossicular Reconstruction 69636 Auriculectomy 69120 Canaloplasty 69310 Drainage of Abscess or Hematoma 69000 Foreign Body Removal from the Ear 69200 Facial Nerve Repair, Graft or Interposition 69740 Construction / Reconstruction of Auricle 21230 Otoplasty 69300 Ear Examination Under Anesthesia 92502 COSMETIC Blepharoplasty - Upper 15823_3 Blepharoplasty - Lower 15821_3 Brow Lift 67900_3 Buccal Fat Excision 15839 Cheek Lift 15828 Chin Implant 21120 Facial Injection or Grafting 15840 Facial Osteotomy / Genioplasty 21198 Liposuction - Face 15876 Mandibular Implant 21125 Malar Implant 21270 Otoplasty 69300 Rhinoplasty 30400 Rhytidectomy 15828 Submental Lipectomy 15838 Surgical Treatment of Ear Keloid 11442 Temporal Lift 15824 Chemical Peel 15788 Dermabrasion 15780 Laser Resurfacing 17004 Scar Revision - Complex 11444 Scar revision - Simple 11440 Surgical Treatment of Keloid 11422 4 OF 6
SKIN AND SOFT TISSUE (SST) Incision & Drainage of Cutaneous Abscess or Hematoma 10060 Removal of Foreign Body 10120 Debridement of Wound Simple 11000 Debridement of Wound Complex 11010 Repair of Laceration Simple 12011 Repair of Laceration Complex 13131 Excision of Lip Lesion 40510 Biopsy of Skin Lesion 11400 Excision of Benign Skin Lesion 11420 Excision of Malignant Skin Lesion 11620 Reconstruction of Eyelids 67971 Tarrsoraphy 67875 Gold Weight Insertion to the Eyelid 67911 Lateral Canthopexy 67950 Ptosis Repair 67901 Filler/Implant Hair Flaps/Grafts Static Procedures for Facial Palsy 15840 Scar Revision (Not Cosmetic) 14040 Mid-Face Lift (Not Cosmetic) 15828 Rhytidectomy (Not Cosmetic) 15829 Surgical Treatment of Ear Keloid 11433 Repair Soft Tissue Injury 13153 Repair Lacrimal Duct 68700 Repair Eyelid Laceration 65273 Repair Ear Superficial 13160 Repair Ear Complex 16160 Acute Debridement and Grafting, Burns 16030 Late Reconstruction, Burns Scar Revision, Complex Depends on Site Size 14000-14302 Scar Revision, Simple Depends on Site Size 13100-13153 Surgical Treatment of Keloid 12031 Split Thickness Skin Graft 15120 Full Thickness Skin Graft 15200 Skin and Fascial Flaps 14060 Tissue Expansion 19357 Excision Benign Lesions, Head and Neck 11420 Excision Benign Lesions, Elsewhere 11400 Excision Malignant Lesion, Head and Neck 11620 Chemical Peel (Not Cosmetic) 15788 Dermabrasion (Not Cosmetic) 15780 Fat Grafting (Not Cosmetic) 15770 LASER CO 2 KTP Erbium Etc ADMINISTRATION OF SEDATION AND ANALGESIA 5 OF 6
LEVEL II ADVANCED PRIVILEGES MICROVASCULAR Free Tissue Transfer 41155 LARYNX / TRACHEA Denervation of Recurrent Laryngeal Nerve 31595 Reinnervation of Recurrent Laryngeal Nerve 31590 Laryngoplasty 31588 Tracheoplasty 31750 Segmental Tracheal Resection 31780 OTOLOGIC Stapedectomy 69660 Vestibular Nerve Section 69915 Acoustic Neuroma Resection 69970 CSF Leak Repair 61618 Labyrinthectomy 69905 Excision of Skull Base Tumor 69970 Cochlear Implantation 69930 Temporal Bone Resection 69535 Facial Nerve Decompression 69955 CRANIOMAXILLFACIAL Cleft Lip Repair, Unilateral 40700 Cleft Lip Repair, Bilateral 40701 Cleft Palate Repair 42200 Primary Cleft Lip Rhinoplasty 40700 Secondary Repair Cleft Lip 40720 Secondary Cleft Lip Rhinoplasty 30460 Alveolar Bone Graft 42210 Palatal Fistula Repair 42260 Pharyngeal Flap or Pharyngoplasty 42225 Other Facial Cleft Repair 40700 Reconstruction Microtic Ear, 1 st Stage 21230 Reconstruction Microtic Ear, Subsequent Stage 21230 Correction Eyelid Ptosis 15822 Mandibular Osteotomy 21195 Placement Mandibular Craniofacial Distraction Device 21110 Remove Mandibular Craniofacial Distraction Device 20694 Maxillary Osteotomy 21141 Placement Maxillary / Craniofacial Distraction Device 21110 Remove Maxillary / Craniofacial Distraction Device 20694 Major Craniofacial Reconstruction 21175 Liposuction for Congenital Asymmetry 15830 Dynamic Procedures for Facial Palsy 15732 Facial Re-Innervation 15842 ROBOTICS (contact Perioperative Services for Robotic Privileging) 6 OF 6