Code First / Use Additional Code
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a 'use additional code' note at the etiology code, and a 'code first' note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
Following the physical examination, biopsies and imaging studies, the patient and family should meet with the skull base team — ear surgeon, head and neck surgeon, neurosurgeon, and in some cases plastic surgeon and eye surgeon. Discussions should include the possibility of facial nerve removal and grafting, if the tumor has invaded the facial nerve. In addition, most patients with extensive tumors will lose the hearing and balance functions of the inner ear. In order to isolate the tumor and remove it completely, portions of the ear canal, mastoid and inner ear will be removed in an “enbloc” operation. This means that the structures of the ear canal, drum, middle ear, and inner ear are removed in one piece. This technique reduces the possible spillage of tumor to adjacent sites, but provides a greater chance of cure.
The gall bladder channel of the Foot-Shaoyang starts from the outer canthus of the eye, and desends to the anterior aspect of the ear. Then ascends to the corner of the forehead, and then winds downward posterior to th ear. Then arches forward to the forehead at the midpoint of the eyebrow. It then runs above the hairline to the lateral side of the neck. Travels highest point of the trapezius muscle. From there it further descends to the axilla and enters the chest. It then travels interiorly in the hypochondriac region, emerging at the lateral side of the lower abdomen near the femoral artery in the inguinal region. Then it curves along the margin of the public hair and runs transversely into the hip region. It then travels downward along the lateral side of thigh to the lateral side of the knee. Further descending along the anterior aspect of the fibula, it reaches the lower end of the fibula, and the anterior aspect of the lateral malleolus. Following the dorsum of the foot, it terminates at the lateral side of the fourth toe's tip.