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	Archive > November, 2002	Vol. III, No. 11

How to Bring 4 New ENT Tools and Procedures to Your Facility

Recent advances have made existing ENT procedures go more smoothly and made new procedures possible

Carol Covell, RN

Quick Links:

Click here to view a case cart involving Laryngeal Nerve Monitoring for a thyroidectomy

Click here to view a case cart involving a 585-NM pulse dye laser in laryngology

Click here to view a case cart involving Image-Guided FESS

Click here to view a case cart involving Sleep Apnea Surgery performed by uvulopalatalpharyngoplasty.

There are four of the newer otolaryngology techniques performed at the Massachusetts Eye and Ear Infirmary and some tips on offering these services at your facility.

Laryngeal Nerve Monitoring during Thyroid Surgery

Background. About 10 percent of outpatient thyroid surgeries result in temporary or permanent paralysis of a vocal cord and nearly 3 percent of patients are left with paralysis of both vocal cords, a condition that makes breathing difficult and often requires a tracheotomy. The recurrent laryngeal nerve (RLN), which powers the vocal cords as well as the "door" to the airway, is easily injured. It's the only nerve in the body that cannot be repaired if it's damaged. Research has shown that the use of nerve monitors during surgery can sharply reduce the risk of this complication.
Capital equipment. Our facility has a $20,000 monitor that helps locate as well as monitor the laryngeal nerve for the surgeon. Although standard nerve monitors used for most head and neck surgeries will not locate the RLN for the surgeon, they can still greatly reduce the risk of RLN injury.

If you don't have nerve monitors on hand, an April 2002 study in the Archives of Surgery suggested an inexpensive alternative: using a laryngeal mask airway (LMA), combined with electrical RLN stimulation and a fiberoptic video laryngoscope to confirm vocal cord response.
Staffing. You'll need an audiology tech, proficient in laryngeal nerve monitoring. Otherwise, your core staffing requirements are an RN circulating nurse, a scrub tech and an anesthesiologist/CRNA.
OR-set up. You'll need to be set up for Zomed Nim 2 endotracheal tube anesthesia to allow for RLN monitoring by the audiology tech.
Length of procedure. Thyroid surgeries with RLN monitoring take about 4 hours.
Case volumes. There are about 75,000 thyroid surgeries performed each year in the United States. We handle about 5 to 7 cases with RLN monitoring per week or approximately 260 per year.
CPT coding and reimbursement. For CPT code 95920, our labor-adjusted reimbursement is $57.56. Note that RLN monitoring is an adjunct to thyroid procedures, so the stand-alone code does not represent the the actual procedure, for which most of the reimbursement comes from the surgery. Similarly, for the subsequent procedures in this article, which are typically performed and reimbursed along with other procedures, the figure I quote relates to the stand-alone CPT code.

Laryngeal Nerve Monitoring:
This would be the case cart at our facility for a thyroidectomy with RLN monitoring.

Shared Resources:
Cautery (Mentor Wetfield With Ftp), Cautery (Valleylab), Stimulator (Nerve, Monty), Headlight, Light Source (Pilling), Instrument Set (Minor)
Equipment Required:
Thyroid bag with clamp, Mentor Bipolar Box, Monty Nerve Stimulator Box, two fiberoptic sources and headlights, a Valleylab Esu, and a Sequential compression machine.
Items To Have Available:
Sleeve, Seq-Compression, Med Boots, Tray, Cath Foley with Measurit 16, ankle and heel protectors
Instrumentation:
House Soft Tissue Set, Randolph's Retractors, Randolph's Specials, two Long Debakey forceps, two Large Gelpis extra-toothed Gill Forceps, extra -small and large needle holders, Monty nerve stimulator with cord, and scissors.

Drapes

Categories:

ENT

Keywords:

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April; Archives; Available:Sleeve, Seq-Compression, Med Boots, Tray, Cath Foley; Boots, Tray, Cath Foley; CPT; Cath Foley; Cautery; Debakey; Ear Infirmary; Equipment; Eye; FESSClick; Ftp), Cautery; Gelpis; Image-Guided FESSClick; Infirmary; Instrument Set; Large Gelpis; Laryngeal Nerve Monitoring; Light Source; Links:Click; Long Debakey; Massachusetts Eye; Measurit; Med Boots, Tray, Cath Foley; Monitoring; Monty; Nerve Monitoring; Nim; Note; Quick Links:Click; RLN; RN; Required:Thyroid; Research; Resources:Cautery; Seq-Compression, Med Boots, Tray, Cath Foley; Sequential; Sleep Apnea Surgery; Source; Surgery; Thyroid; Tray, Cath Foley; Wetfield Ftp), Cautery; Zomed Nim; actual; adjunct; airway; anesthesia; anesthesiologist/CRNA.OR-set; ankle; approximately; audiology; bag; body; breathing; cart; case; circulating; code; coding; combined; complication.Capital; compression; condition; confirm; cord; core; difficult; dye; easily; electrical; endotracheal; extra; extra-toothed; facility; facility.Laryngeal; fiberoptic; figure; greatly; handle; head; heel; helps; hours.Case; inexpensive; injury.If; involving; labor-adjusted; large; laryngeal; laryngologyClick; laryngoscope; laser; left; locate; makes; mask; monitor; monitoring; monitors; neck; needle; nerve; newer; offering; otolaryngology; outpatient; paralysis; patients; percent; performed; permanent; powers; procedures; proficient; pulse; quote; recurrent; reduce; reimbursed; reimbursement; relates; repaired; represent; requirements; requires; result; risk; scrub; services; set; sharply; shown; sources; staffing; stand-alone; standard; stimulation; stimulator; study; subsequent; suggested; surgeries; surgery; tech; tech.Length; techniques; temporary; thyroid; thyroidectomy; thyroidectomyClick; tips; tube; typically; uvulopalatalpharyngoplasty.There; video; view; vocal; week; year; year.CPT

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