Coding for Otolaryngology Office Procedures.

This review article provides a summary of current correct coding for in-office surgical procedures. The relevant Current Procedural Terminology codes are covered and tips and guidance provided for their correct use. Also, where applicable, facility versus nonfacility reimbursement policy and the associated implications for physicians practicing in hospital-based clinics are discussed.

The Value of Mentorship.

The recent Young Physicians needs assessment survey identified mentorship as the single greatest need for this demographic, which includes physicians under 40 years of age or in their first 8 years of practice after completion of training. Much has been written in textbooks and other journals about mentorship, and as young physicians are certainly not alone in this need, mentorship has become a key focus of future Academy endeavors. Serving as Chair of the Young Physicians Section over the past year has afforded me the opportunity to interact with a variety of dynamic and engaging leaders in our Academy, and herein I provide a synopsis of what these experiences have taught me as well as provide some of the most important pearls that I have picked up along the way.

The Management of Spontaneous Otogenic CSF Leaks: A Presentation of Cases and Review of Literature.

Objective The types of otogenic cerebrospinal fluid (CSF) fistulae were previously classified into defects through, adjacent to, or distal to the otic capsule. This article presents cases of the three different types of spontaneous CSF fistulae and reviews pertinent literature. We examine the management of the different types of otogenic CSF leaks with modern audiovestibular testing, imaging, and surgical techniques. Design Case series and review of the literature. Setting Academic tertiary neurotologic referral practice. Participants Four patients identified through a retrospective search. Main outcome measures Resolution of CSF leak and absence of meningitis. Results Surgical intervention was performed on the four cases described in this series; none had a return of CSF otorrhea in the postoperative period or meningitis. Conclusions Otogenic CSF fistulae may lead to life-threatening infection and in congenital forms are typically not diagnosed unless meningitis has occurred. Rapid and proper recognition, work-up, and treatment of such leaks decrease the risk of permanent neurologic sequelae as well as recurrent meningitis.

Pediatric peritonsillar abscess: Quinsy ie versus interval tonsillectomy.

PERITONSILLAR ABSCESS: Quinsy versus interval tonsillectomy. OBJECTIVES STUDY DESIGN: Case series with chart review. METHODS: We reviewed the records of children treated for peritonsillar abscess between 2007 and 2011 at an academic tertiary pediatric hospital. We identified patients by searching the hospital database for all children treated for the ICD-9 code 475 (peritonsillar abscess). Data points extracted included length of stay, intraoperative blood loss, operative time, and incidence of complications. Statistical analysis was performed to identify significant differences between treatment categories. Children who never received a tonsillectomy (CPT codes 42820/42821/42825/42826) were excluded. RESULTS: 34 children received tonsillectomy for peritonsillar abscess from 2007 to 2011. Of these: 23 received a Quinsy tonsillectomy, and 11 received antibiotics with or without incision and drainage, followed by tonsillectomy a minimum of 2 weeks later. Total hospital days in treatment course was 2.2 days for Quinsy tonsillectomy group and 2.3 days for the interval tonsillectomy group. Estimated blood loss was less than 20 ml for both groups. Operative time was 38 min for Quinsy tonsillectomy and 39 min for interval tonsillectomy. There were no post-tonsillectomy hemorrhages. One patient in the interval tonsillectomy group required readmission for dehydration. CONCLUSION: There were no significant differences in total hospital days, blood loss, operative time, or post-operative complications between Quinsy tonsillectomy and interval tonsillectomy in the treatment of pediatric peritonsillar abscess.

Airway management following pediatric cardiothoracic surgery.

OBJECTIVES: (1) Review airway management in pediatric patients undergoing cardiothoracic surgery (CTS); (2) determine the incidence of airway-related complications of CTS in this population. DESIGN: Case series with chart review. Setting Tertiary care children's hospital. Patients Children undergoing CTS over a 4-year period. METHODS: Patients who underwent CTS at a single, tertiary care, children's hospital between June 1, 2007, and May 31, 2011, were retrospectively reviewed; those <18 years who had open CTS were included. Statistical analysis examined relationships of intubation duration, complications, and need for tracheotomy while comparing patient characteristics, comorbidities, and types of surgery. RESULTS: Eight hundred seventy-five primary surgeries in 745 patients met inclusion criteria. Mean postoperative intubation duration was 7.2 days and median 3 days. On univariate analysis, significantly longer postoperative intubation requirements were found in patients younger in age, with congenital comorbidities or prematurity, with preoperative ventilation requirements, and those with early postoperative complications. Multivariate analysis found younger age, presence of congenital comorbidities, preoperative intubation requirements, and early postoperative complications each lengthen ventilation requirements. Four patients developed vocal cord paralysis and 5 developed phrenic nerve palsy. Nineteen patients required tracheotomy. CONCLUSIONS: In this large cohort, CTS in the pediatric population is associated with few long-term or permanent airway-related complications. Patients who are younger in age and those with congenital comorbidities, preoperative ventilation requirements, or early postoperative complications required longer periods of postoperative intubation.

Successful discontinuation of propranolol for infantile hemangiomas of the head and neck at 12 months of age.

BACKGROUND: Although propranolol can be an effective primary medical therapy for infantile hemangiomas of the head and neck, the duration of treatment and time to discontinue propranolol is unclear. OBJECTIVE: The objective of this study is to determine the duration of treatment and age at which propranolol may be successfully discontinued in children with infantile hemangiomas of the head and neck. METHODS: A review of all patients presenting to a pediatric vascular anomalies clinic from January 2008 to December 2011 was performed. Those with head and neck infantile hemangiomas who completed propranolol therapy were included. Each patient's records were reviewed for demographics, clinical response to propranolol, age at discontinuation of propranolol, and adverse events. RESULTS: Forty-five patients were included for review (mean age at presentation, 3.5 months) with all demonstrating positive responses. The mean age at discontinuation of propranolol was 11.8 months of age (range, 8-15 months) with a mean treatment duration of 6.5 months (range, 3-11 months). No recurrences were noted over a mean follow-up period of 19.9 months (range, 10-28 months). CONCLUSION: Discontinuation of propranolol at approximately 12 months of age was found to be appropriate in our study population.

Survey of Ménière's disease in a subspecialty referral practice.

OBJECTIVES: To define the prevalence of definite Ménière's disease (MD) among patients presenting with characteristic symptoms and examine the utility of published diagnostic guidelines. STUDY DESIGN AND SETTING: Retrospective review in an academic referral practice. RESULTS: The prevalence of definite MD in these 295 individuals was 64%. The next-largest group (23%) consisted of patients with only cochlear symptoms. Those initially classified as probable are usually reclassified as definite with extended follow-up. Of those with definite MD, the mean duration of disease at last follow-up was 7.6 years, 56% were female, 19% had bilateral disease, and 34% required surgical management for vertigo. CONCLUSIONS: The 1995 AAO-HNS guidelines are useful for classification of MD according to certainty of diagnosis and severity of disease, though some modifications could be considered. SIGNIFICANCE: Application of consistent diagnostic criteria is essential for epidemiological, genetic, or outcomes studies of Ménière's disease.