procedure(s) after septoplasty

My ENT doctor has had his patient back on a couple occasions now after his septoplasty was done. (currently 60 days post-op) He has had to manipulate and elevate the nasal bone and place a Gelfoam pack to hold the bone in place. Is this included in the global of the surgery, or can we bill a procedure for this?? (note attached)

Thanks!

Patient returned for followup. He has redeveloped some collapse of the nasal bone on the left side. Subsequently, he has noted some decrease in airflow on that side.

I think that the nasal bone has once again collapsed. As this heals, I hope that it will stiffen and we will have a longer duration of elevation post-manipulation. He agreed to have another manipulation of the depressed nasal bone with reinsertion of a Gelfoam pack to hold it up. I anesthetized the left side of his nose with lidocaine and oxymetazoline spray. I then placed some lidocaine, oxymetazoline and a cotton ball underneath the depressed nasal bone. That is set there for about 15 minutes. On completion, he was completely anesthetized. I was then able to pass a Goldman septum displacer high into the nasal vault and elevate the bone. I then placed a folded Gelfoam underneath the bone holding into position. With his elevated nasal bones, the nasal appearance was restored. He also noted dramatic improvement of breathing on that side as well.

I am optimistic that ultimately we can get the bone to heal in its normal position if we keep elevating it as it heals. I will see him in followup in 2 weeks.

FINAL DIAGNOSIS: Postnasal fracture sequelae.

procedure(s) after septoplasty