Clinical Indicators: Nasal Fracture (with or without septal fracture)

1. History (required)
   1. Recent nasal trauma with deformity
2. Physical Examination (required)
   1. Evidence of nasal septal fracture (with or without concomitant nasal fracture)
   2. Description of complete intranasal examination with documentation of
      1. obstruction
      2. hematoma
      3. septal deviation
      4. septal perforation
      5. rhinorrhea (assess for CSF leak)
3. Tests (not required but may be obtained for other indications such as a concomitant external deformity)
   1. Imaging studies (optional)
   2. Pre-operative photographs (optional)

Postoperative Observations

1. Skin edema and ecchymosis?
2. Packing or internal splint in the desired position? If packing or splints were placed, were they subsequently removed?
3. Pain? (the surgeon should be notified if progressive or severe)
4. Bleeding? (the surgeon should be notified)
5. Purulent drainage (fit w/1a)

Outcome Review

1. One Week
   1. Healing–Did patient require treatment for bleeding, septal hematoma or infection?
   2. Appearance–Is fracture reduction satisfactory?
   3. Nasal airway evaluation–Is the airway patent? Is there a perforation? Are there synechiae?
2. Beyond Two Months
   1. Appearance–Is appearance of nose improved (if external deformity was also addressed)?
   2. Nasal airway evaluation
      1. Is nasal breathing satisfactory? How was this assessed?
      2. If nasal obstruction existed pre-operatively, is it improved?
      3. Are there synechiae? (How will this be addressed?)
      4. Is there a septal perforation? (How will this be addressed?)
      5. Discuss timing of revision surgery if necessary

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

• J34.2 Deviated nasal septum
• S022XX- Fracture of nasal bones

The appropriate 7th character is to be added to each code from category S02
A – initial encounter for closed fracture
B – initial encounter for open fracture
D – subsequent encounter for fracture with routine healing
G – subsequent encounter for fracture with delayed healing
K – subsequent encounter for fracture with nonunion
S – sequela

Additional Information

Assistant Surgeon — N

Patient Information

Nasal fractures are common. If no airway obstruction or nasal deformity has occurred due to the fracture, surgical treatment may not be needed. For nasal fractures resulting in deformity or airway obstruction, surgery may be indicated to open the nasal passage and/or improve appearance. Surgery for nasal trauma may not be able to completely correct the traumatic deformity and/or may not correct preexisting deformities. Nasal infection, bleeding, or hematoma are possible, yet infrequent complications.

Important Disclaimer Notice

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.

CPT five-digit codes, nomenclature and other data are copyright 2014 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.

© 2014 American Academy of Otolaryngology-Head and Neck Surgery.