Clinical Indicators: Rhinoplasty

1. History (one or more required)
   1. Obstructed breathing (functional).
   2. Unsatisfactory appearance.
   3. Nasal injury (trauma) causing unsatisfactory breathing and/or appearance.
   4. Nasal birth defect impairing nasal function.
   5. Acquired deformity due to trauma, tumor or infection.
2. Physical Examination (all required)
   1. External nasal anatomy including description of deformity.
   2. P Internal nasal anatomy including description of septum and inferior turbinates.
   3. Patency of nasal passages including estimate of percentage obstruction for each side.
3. Tests (required & dated within 3 mo. of surgery)
   1. Pre operative photographs

Postoperative Observations

1. Skin edema and ecchymosis–documented observation.
2. Nasal packing in desired location or removed?
3. Pain–does patient require discharge prescription?
4. Bleeding–how managed? Surgeon informed?

Outcome Review

1. One Week
   1. Healing–Did patient require treatment for bleeding, infection or obstruction?
   2. Healing of graft donor site when appropriate.
2. Beyond One Month
   1. Appearance–Appraisal of result comparing post operative and pre-operative photographs.
   2. Airway–Are nasal passages patent?
   3. Healing of graft donor site when appropriate.

Associated ICD-10-CM Diagnostic Codes (Representative, but not all-inclusive codes)

• A50.57 Syphilitic saddle nose
• J34.2 Deviated nasal septum
• S02.0XXS Fracture of vault of skull, sequela
• S02.10XS Unspecified fracture of base of skull, sequela
• S02.110S Type I occipital condyle fracture, sequela
• S02.111S Type II occipital condyle fracture, sequela
• S02.112S Type III occipital condyle fracture, sequela
• S02.113S Unspecified occipital condyle fracture, sequela
• S02.118S Other fracture of occiput, sequela
• S02.119S Unspecified fracture of occiput, sequela
• S02.19XS Other fracture of base of skull, sequela
• S02.2XXS Fracture of nasal bones, sequela
• S02.3XXS Fracture of orbital floor, sequela
• S02.400S Malar fracture unspecified, sequela
• S02.401S Maxillary fracture, unspecified, sequela
• S02.402S Zygomatic fracture, unspecified, sequela
• S02.411S LeFort I fracture, sequela
• S02.412S LeFort II fracture, sequela
• S02.413S LeFort III fracture, sequela
• S02.42XS Fracture of alveolus of maxilla, sequela
• S02.5XXS Fracture of tooth (traumatic), sequela
• S02.600S Fracture of unspecified part of body of mandible, sequela
• S02.609S Fracture of mandible, unspecified, sequela
• S02.61XS Fracture of condylar process of mandible, sequela
• S02.62XS Fracture of subcondylar process of mandible, sequela
• S02.63XS Fracture of coronoid process of mandible, sequela
• S02.64XS Fracture of ramus of mandible, sequela
• S02.65XS Fracture of angle of mandible, sequela
• S02.66XS Fracture of symphysis of mandible, sequela
• S02.67XS Fracture of alveolus of mandible, sequela
• S02.69XS Fracture of mandible of other specified site, sequela
• S02.8XXS Fractures of other specified skull and facial bones, sequela
• S02.91XS Unspecified fracture of skull, sequela
• S02.92XS Unspecified fracture of facial bones, sequela
• M95.0 Acquired deformity of nose
• Q30.1 Agenesis and underdevelopment of nose
• Q30.2 Fissured, notched and cleft nose
• Q30.8 Other congenital malformations of nose
• Q30.3 Congenital perforated nasal septum
• Q30.9 Congenital malformation of nose, unspecified
• Q67.0 Congenital facial asymmetry
• Q67.1 Congenital compression facies
• Q67.2 Dolichocephaly
• Q67.3 Plagiocephaly
• Q67.4 Other congenital deformities of skull, face and jaw

Additional Information

Assistant Surgeon — N
Supply Charges — N
Prior Approval — Y
Anesthesia Code(s) — 00160

Patient Information

Rhinoplasty or reconstruction of the nose is performed to improve appearance and/or function. Consequently, the risks of this surgery involve not only failure to attain a desirable cosmetic result but also failure to maintain or improve the breathing function. Examples of undesirable functional results are noisy or obstructed breathing and nasal crusting. Judging the cosmetic result is subjective. In the best result, the nose has a natural look. As every face is different, so is every nose. A nose that may be attractive on one person may be unattractive for another; it must be tailored to the individual. The training of surgeons, who perform rhinoplasty, should include both rhinology and plastic surgery techniques, so they may be familiar with the internal anatomy and function of the nose, as well as with reconstruction and appearance of the external nose.

Important Disclaimer Notice (Updated 8/7/14)

Clinical indicators for otolaryngology serve as a checklist for practitioners and a quality care review tool for clinical departments. The American Academy of Otolaryngology—Head and Neck Surgery, Inc. and Foundation (AAO-HNS/F) Clinical Indicators are intended as suggestions, not rules, and should be modified by users when deemed medically necessary. In no sense do they represent a standard of care. The applicability of an indicator for a procedure must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical indicators will not ensure successful treatment in every situation. The AAO-HNS/F 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. The AAO-HNS/F is not responsible for treatment decisions or care provided by individual physicians. Clinical indicators are not intended to and should not be treated as legal, medical, or business advice.

CPT five-digit codes, nomenclature and other data are copyright 2009 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein.

© 2010 American Academy of Otolaryngology-Head and Neck Surgery.