Created Aug 2018
Reviewed Dec 2019
What ACHI codes are assigned for “Excision of right parapharyngeal tumour via lip split/mandibulotomy”?
Provided below is the relevant section for the operation note.
Lower lip splitting incision curving around the right side of the chin and into the upper neck incision. The mandibular parasymphyseal region was exposed subperiosteally and the mental nerve identified.
The site for an osteotomy between the 43/44 tooth roots was marked. A striker 2.3mm recon plate was then applied and pre-contoured, and pre-plated with titanium screws. The plate was then removed and the osteotomy performed.
Mandibular swing then carried out with incision along the mucosal of the floor of the mouth to the retromolar trigone region. The lingual nerve was protected throughout. The tumour in the parapharyngeal space was easily identified and was well encapsulated. It was shelled out in entirety with no breach to the capsule.
Mandible fixated using pre-drilled plate.
In the absence of a specific code or index entry for excision of parapharyngeal tumour via transmandibular approach, assign codes 31409-00  Excision of parapharyngeal lesion by cervical approach with free text to specify the transmandibular approach and 45723-00  Osteotomy of mandible with internal fixation, unilateral.