S136
Otolaryngology–Head and Neck Surgery,  145(2S)
to improve compliance. Both records were also available to the
referring physician to review.
Conclusion: Through the digital recording of patient encoun-
ters, we hope to improve clinical efficiency, coding accuracy,
patient compliance, and referring physician gratification.
Business of Medicine
Resident Education of
Documentation and Coding
Kristen R. Boyle, MD (presenter); Adrian Gooi,
MD; Deborah Sue Follmer Kacmarynski, MD;
Nitin A. Pagedar, MD; Richard J. H. Smith, MD
Objective: 1) Develop resident billing/coding education based on a
needs-based assessment; 2) Expand systems-based practice com-
petency; 3) Empower residents with a broader skill set; 4) Mini-
mize risk exposure via adequate documentation; 5) Examine resi-
dent billing practices and estimate potential billing errors.
Method: A sample of residents and attendings from our otolaryn-
gology program were administered a pretest/written survey on
knowledge/opinions of documentation and coding for physician
services. Responses were used to create multi-modality educa-
tional intervention. Resident billing was used to assess pre/post-
intervention ability to bill for physician services in an outpatient
clinic setting.
Results: A total of 12 out of 13 staff reported that residents did
not demonstrate ability to document and code. No residents
currently perform billing, but 12 of 14 assume that they will
be in the future. All the residents believed billing training was
useful, although 2 did not think it should be taught during
POSTERS
residency. A total of 17% of 60 pre-intervention encounters
were accurately coded. A total of 68% of total encounters
resulted in underbilling by an average of $22/encounter and
15% of total encounters resulted in overbilling by an average
of $35/encounter. Total lost charges across all encounters
were estimated at $909.00 due to inappropriate coding and
$710.00 due to insufficient documentation.
Conclusion: Residents are not currently educated regarding
documentation and coding for physician services. Therefore,
they have a limited understanding of documentation/coding
for physician services as evidenced by inaccurate shadow bill-
ing. All residents acknowledge that this topic is important to
their career with a majority of them interested in learning this
information while in residency training.
Facial Plastic and Reconstructive
Surgery
A Novel Technique in Repair of
Moderate-sized Nasal Septal
Perforations
Nikhila Raol, MD (presenter); Krista L Olson, MD
Objective: 1) Describe a novel technique which has been successful
in closure of moderate-sized nasal septal perforations. 2) Review
Downloaded from oto.sagepub.com by guest on June 4, 2016
the current literature on various techniques that have been previ-
ously described for closure of nasal septal perforations.
Method: Retrospective review of a successful technique used
at our institution for closure of septal perforations over a
5-year span (2006-2010) at a facial plastic surgery practice.
Charts were reviewed to find patient characteristics, symp-
toms, etiologies of perforation, and outcomes, including
patient satisfaction and rate of recurrent perforation.
Results: Over the past 5 years at our institution, 12 patients were
identified with nasal septal perforations, which were closed using
bilateral mucosal advancement flaps: one inferiorly-based flap
advanced from the floor of the nose and another superiorly-based
flap advanced from the lateral nasal wall and upper lateral carti-
lage. The size of the perforations ranged from 0.6 cm to 1.6 cm.
The majority of patients had excellent outcomes with resolution
of symptoms and a low rate of recurrence.
Conclusion: Nasal septal perforations have been approached
traditionally with 2 superiorly based or 2 inferiorly based flaps.
We present a technique with a combination of both flaps for
closure of a moderate-size perforation. This decreases the risk
of recurrence of the perforation, flap necrosis, and develop-
ment of a new perforation.
Facial Plastic and Reconstructive
Surgery
Analysis and Optimization of the
Rhombic Flap Wound Closure
Shelby Gates Topp, MD (presenter);
Curtis Gaball, MD; Scott Lovald; Tariq Khraishi
Objective: 1) Develop a hyperelastic computational model of skin
viscoelastic properties for analysis of wound closures, and 2)
Apply the model to variations of the rhombic skin flap to quantify
closure force vectors and optimize wound closure tension.
Method: A computational model employing the finite element
method was created to simulate skin defect closure employing
rhombic transposition flaps. Variables of transposition angle,
flap width, and tissue undermining were analyzed. Outcome
measures of tissue stress, strain, and wound distortion were
evaluated and optimized for a standard defect.
Results: A second order Yeoh hyperelastic model was fit to previ-
ously published experimental skin data with good approximation
of observed properties. In the analysis of transposition flap clo-
sures of the 60 to 120 degree rhomboid defect, the model sug-
gests that a biomechanically ideal flap design is constructed with
distal flap angle of 30 degrees, as is employed in the Webster flap,
with the donor site near margin oriented parallel to the short axis
of the defect, as in the traditional Limberg flap. This configura-
tion minimizes tissue stress and strain and most evenly distributes
wound tension across the closure line.
Conclusion: The model quantitatively demonstrates several
recognized principles of the rhombic flap. Square defects, as
compared with rhomboid defects, close with lower tissue
strain, but form a larger standing cutaneous deformity.