1101 Erie Blvd E Suite 200
Syracuse NY 13210
Medical School: Hahnemann University College Of Medicine - 2000
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: Yes
License #: 2398491
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Awards & Recognitions
Dr. Parul Goyal is associated with these group practices
|HCPCS Code||Description||Average Price||Average Price
Allowed By Medicare
|HCPCS Code:31288||Description:Nasal/sinus endoscopy surg||Average Price:$1,546.67||Average Price Allowed
|HCPCS Code:30520||Description:Repair of nasal septum||Average Price:$1,500.00||Average Price Allowed
|HCPCS Code:31237||Description:Nasal/sinus endoscopy surg||Average Price:$648.00||Average Price Allowed
|HCPCS Code:31231||Description:Nasal endoscopy dx||Average Price:$450.00||Average Price Allowed
|HCPCS Code:99204||Description:Office/outpatient visit new||Average Price:$270.00||Average Price Allowed
|HCPCS Code:99203||Description:Office/outpatient visit new||Average Price:$165.00||Average Price Allowed
|HCPCS Code:99212||Description:Office/outpatient visit est||Average Price:$83.18||Average Price Allowed
HCPCS Code Definitions
- Nasal/sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid sinus
- Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft
- Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)
- Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)
- Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
- Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.
Medical Malpractice Cases
Medical Board Sanctions
*These referrals represent the top 10 that Dr. Goyal has made to other doctors
Patterns and sequelae of sphenoid sinus fractures. - American journal of rhinology & allergy
The sphenoid sinus is one of the most commonly fractured regions of the skull base after blunt head trauma. These fractures may be associated with complications such as blunt carotid artery injury (BCAI) and cerebrospinal fluid (CSF) leak. Association of these sequelae with sphenoid sinus fractures has yet to be analyzed thoroughly in the literature.Analyze patterns of traumatic sphenoid sinus fractures and assess relationships between fracture patterns and incidence of BCAI and traumatic nasal CSF leaks.A retrospective review of 123 patients sustaining sphenoid sinus fractures was performed. Patient medical records and radiographic images were reviewed. Fractures were classified based on the sinus walls involved. Logistic and linear regressions were used to analyze associations between injury mechanisms, fracture subsites, and sequelae.The most commonly fractured sphenoid sinus subsites included the carotid canal, sphenoid roof, and lateral wall (60%, 49% and 48%, respectively). CSF leaks occurred in 9% of sphenoid sinus fractures, whereas BCAI occurred in 1.6%. On logistic regression, sphenoid roof fractures were significantly associated with CSF leaks (odds ratio [OR] = 12.4, p = 0.002). No fracture subsite was associated with BCAI. The positive predictive value (PPV) of sphenoid roof fractures for the presence of CSF leaks was 17%, whereas the negative predictive value (NPV) was 98%. The PPV of carotid canal fractures for BCAI was 3%, whereas the NPV was 100%. There was no association between the number of fractured sinus walls and the incidence of BCAI or CSF leak. Penetrating injuries were significantly associated with CSF leak (OR = 24.7, p = 0.01), but no other injury mechanisms were associated with BCAI or CSF leak.Nasal CSF leak was the most common sequela of sphenoid sinus fractures, whereas BCAI was extremely uncommon. Analysis of fracture patterns can be useful in determining the need for additional evaluation.
Xanthomatous hypophysitis. - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
We present a 69-year-old woman who presented with chronic headaches and was found to have a pituitary mass on MRI, which was biopsied and said to be lymphocytic hypophysitis. The woman was placed on prednisone and followed with routine eye examinations. Two years later, the lesion gradually increased in size and the woman developed a decrease in peripheral vision in the right eye. An MRI showed abutment of the right optic nerve by the mass. A repeat endoscopic transsphenoidal biopsy/resection of the pituitary lesion was performed. Histopathological analysis of the specimen was consistent with diagnosis of xanthomatous hypophysitis (XH). XH is an inflammatory disorder of the pituitary gland characterized by an infiltration of lipid-laden histiocytes, also known as xanthoma cells. The mass was biopsied and a diagnosis of lymphocytic hypophysitis was made. The woman reported improved visual acuity and peripheral vision postoperatively. One year after the second resection, her visual symptoms worsened. Repeat MRI revealed expansion of the residual pituitary tissue. She was referred to the radiation oncology department for external beam radiation therapy and was placed on a maintenance dose of steroids. Since undergoing radiation therapy, her vision has improved slightly and her 3month MRI revealed stable lesion size. This woman illustrates a rare pituitary pathology presented with a literature review of published patients describing xanthomatous hypophysitis. A discussion of the clinical presentation, epidemiology, etiology, diagnosis, histology and treatment is provided.Copyright Â© 2015 Elsevier Ltd. All rights reserved.
What does Medicare pay rhinologists? An analysis of Medicare payment data. - International forum of allergy & rhinology
Information about charges and payments for physician services continues to be scrutinized. Recently, the Centers for Medicare and Medicaid Services (CMS) released data regarding Medicare charges and payments to all physicians for calendar year 2012. The purpose of this study was to investigate the variability and patterns in Medicare charges and payments among a large sample of rhinologists.Charge and payment data were obtained from publicly available CMS datasets (http://www.cms.gov). Data for all otolaryngologists and rhinology subsets were extracted. Charges, payments, fee multipliers, and total submitted claims were compared. Unequal variance 2-tailed t tests were used for analysis.Mean submitted charges for rhinologists were $291,464 compared to $211,209 for all otolaryngologists (p = 0.0014). Mean payments to rhinologists were $70,172 compared to $77,275 for all otolaryngologists (p = 0.24). Fees for services ranged from 1.33 to 14.29 times Medicare reimbursement rates (mean = 4.47). The fee multiplier was significantly higher for operating room-based codes compared to office-based codes (9.43 vs 3.44, p < 0.001). Academic rhinologists submitted fewer claims and had a higher fee multiplier than private rhinologists (p < 0.001). Academic and private rhinologists had no difference in submitted charges (p = 0.28).The wide availability of Medicare payment information makes it important for physicians to understand how their individual data compares to that of their colleagues. Medicare payments to rhinologists were comparable to otolaryngologists as a whole. Charges for services commonly performed by rhinologists vary widely. Academic rhinologists submitted fewer claims than their private colleagues, but overall charges and payments were comparable between the 2 groups.Â© 2015 ARS-AAOA, LLC.
Delay in specimen processing-major source of preanalytical variation in serum electrolytes. - Journal of clinical and diagnostic research : JCDR
To evaluate the stability of electrolytes in serum samples due to delay in analysis in a tertiary care government hospital in India, and the maximum time delay acceptable between sample centrifugation and analysis.We estimated serum electrolytes of 400 samples with different time intervals between centrifugation and sample analysis on automated analyser.Values were compared using repeated measure ANNOVA and acceptable limit change using in house QC values of 6 months. During the time interval between centrifugation and sample analysis, the samples were kept uncovered in sample cups in the laboratory. Potassium values show significant changes within 1 h (T1, p<0.01) but sodium (T2, p <0.01) and chloride (T2, p <0.001) values are acceptable up to a time delay of 3 h between sample centrifugation and analysis.Samples for electrolytes should be analysed within 1-2 h of centrifugation and if there is any delay in analysis, the samples should be stored under proper conditions.
Current trends in surgical approach and outcomes following pituitary tumor resection. - The Laryngoscope
The goals of pituitary tumor resection include normalizing endocrine function, relieving mass effect, and minimizing risk of recurrence. This study investigated current trends in costs and complications for transfrontal and transsphenoidal pituitary surgery.Retrospective review of the 2008-2011 Nationwide Inpatient Sample for patients undergoing pituitary lesion resection.Demographics and outcomes were compared between transfrontal and transsphenoidal surgical approaches using Ï‡(2) tests. Multivariate analysis was performed to investigate outcomes while controlling for confounders.There were 8,543 admissions for resection of pituitary lesions that met our inclusion criteria. Most (>90%) were treated transsphenoidally. The transfrontal approach was most frequent in the young (<35 years) and in the South. Rates of mortality and complications were higher in patients undergoing transfrontal surgery. Multivariate analysis found transsphenoidal resection was associated with a reduction in hospital costs and length of stay by over 50%; low-volume hospitals had increased cost and length of stay. There was an increased rate of transfrontal approaches at low-volume centers.Multiple factors influence outcomes of pituitary tumor resection. Transsphenoidal pituitary surgery is associated with a shorter length of stay, lower cost, and lower complication rates when compared to transfrontal surgery. Case specifics, including tumor location and size, influence approach and lead to a selection bias that cannot be controlled for in the present study. The prevalence of transfrontal resections at low-volume centers may indicate an area of further investigation. Additionally, when controlling for surgical approach, low-volume centers were found to adversely affect economic outcomes and also warrants investigation.2c. Laryngoscope, 125:1307-1312, 2015.Â© 2015 The American Laryngological, Rhinological and Otological Society, Inc.
Significant increases of pituitary tumors and resections from 1993 to 2011. - International forum of allergy & rhinology
Pituitary tumors comprise 10% to 15% of all diagnosed intracranial tumors; 90% are adenomas. Though benign, significant morbidity via compression of surrounding structures or aberrant hormone secretion can occur. This study investigated rates of pituitary tumor diagnoses and treatment trends from 1993 to 2011.This study was a retrospective review of the 1993 to 2011 Nationwide Inpatient Sample for patients diagnosed with pituitary tumor as well as those patients who underwent pituitary tumor resection. Incidences of pituitary lesions, surgical approaches, and clinical and economic outcomes were evaluated.The rate of primary and secondary diagnoses of pituitary tumor per 100,000 persons significantly grew over the study period (correlation coefficient = 0.934 and 0.987, respectively, p < 0.001); a significant increase in the number of pituitary resections performed annually (correlation coefficient = 0.942, p < 0.001) were also seen. Admissions with a primary diagnosis of pituitary neoplasm experienced significant decreases in length of stay over time (correlation coefficient = -0.913, p < 0.001) and mortality (correlation coefficient = -0.697, p = 0.001). Interestingly, hospital charges more than triple over the same time span (correlation coefficient = 0.970, p < 0.001). Transfrontal resections decreased linearly with time.Pituitary tumor diagnoses and resections have grown significantly over the past 20 years. Transsphenoidal surgical resection among this patient population has increased significantly, whereas transfrontal resections have decreased.Â© 2014 ARS-AAOA, LLC.
Managing the frontal sinus in the endoscopic age: has the endoscope changed the algorithm? - Craniomaxillofacial trauma & reconstruction
Management of fractures involving the frontal sinus seems to be more complex than merely obtaining an ideal reduction of the bony injuries. Multiple articles on the management of these fractures suggest that a great deal of controversy persists despite many years of surgical experience. The question posed in this article is whether or not the advent of endoscopic approaches has changed or should change the approaches/algorithms used in the management of these challenging fractures. It is the conclusion of these authors that endoscopic techniques can indeed allow us to change the algorithm for management of frontal sinus trauma. New algorithms are proposed that should provide guidance to craniomaxillofacial surgeons treating these injuries in the endoscopic age.
Insulating and cooling effects of nasal endoscope sheaths and irrigation. - International forum of allergy & rhinology
Heat generated at the tips of nasal endoscopes have been shown to reach temperatures high enough to cause thermal tissue injury. Endoscope sheaths have the potential to minimize the risk of thermal tissue injury. The purpose of this study was to assess the abilities of plastic and metal endoscope sheaths and sheath irrigation to insulate against dangerous scope tip temperatures.A 4-mm 0-degree rigid nasal endoscope was used with light-emitting diode (LED) and xenon light sources (400-W LED, 300-W, and 175-W xenon) to assess scope tip temperature before and after endoscope sheath placement. Temperatures were assessed again after placement of each sheath, both before and after active saline irrigation. Scope tip temperature was measured using a noncontact infrared thermometer.The unsheathed rigid scope tip reached a maximal temperature after 10Â minutes at 100% light source intensity. The 400-W LED and 300-W xenon sources generated potentially dangerous scope tip temperatures exceeding 42Â°C, whereas the 175-W xenon source never generated a maximal temperature over 32.6Â°C. After placement of plastic and metal sheaths, mean scope tip temperatures were decreased by 2Â°C (4.8%) and 2.2Â°C (5.5%), respectively. After active saline irrigation, mean scope tip temperatures were decreased by 5.1Â°C (12.6%) and 5.2Â°C (12.8%), respectively.With modern light sources, nasal endoscopes have the potential to reach temperatures that may cause thermal tissue injury. Endoscope sheaths lead to decreases in scope temperatures, and the effect is greater with active irrigation. In addition to improving visualization, endoscope sheaths may decrease the risk of thermal tissue injury.Â© 2014 ARS-AAOA, LLC.
Trends of online ratings of otolaryngologists: what do your patients really think of you? - JAMA otolaryngology-- head & neck surgery
The otolaryngologist's online reputation is of increasing importance. Physician rating websites are becoming increasingly prevalent, and patients are using them to evaluate their current and future physicians.To evaluate patterns in online ratings of otolaryngologists.From May 1, 2013, through June 1, 2013, lists of academic program faculty members in the Northeastern United States were compiled, and academic allopathic otolaryngologists from the Eastern Section of the Triological Society were identified. Each faculty member's name was searched using the Google search engine to link to profiles on the Healthgrades.com and Vitals.com websites.State, program, academic position, years in practice, subspecialty, ratings, and reviews were recorded. Ratings were compared using analysis of variance.A total of 281 faculty members from 25 programs were identified. A total of 266 otolaryngologists (94.7%) had a profile on Healthgrades, and 247 (87.9%) had a profile on Vitals. Of those with profiles, 186 (69.9%) and 202 (81.8%) had patient reviews on Healthgrades and Vitals, respectively. The mean score was 4.4 of 5.0 on Healthgrades and 3.4 of 4.0 on Vitals. On Vitals, 179 profiles (63.7%) had comments associated with them. Overall, 49 comments (27.3%) were determined to be negative, and 138 otolaryngologists (49.1%) had at least 1 negative comment. Academic position and subspecialty affected reviews on Healthgrades. State and years in practice did not influence reviews.Most patients use online resources for information on health care professionals. Physician perceptions of these sites tend to be negative. Awareness of the content and rating patterns may help physicians better manage their online reputation.
Upper lateral strut graft: a technique to improve the internal nasal valve. - American journal of rhinology & allergy
Internal nasal valve (INV) collapse can contribute significantly to nasal obstruction and may be caused by upper lateral cartilage (ULC) collapse medially or laterally. Surgical techniques addressing INV collapse have focused more on treating the narrowed INV angle, with less consideration of the lateral INV area. This article describes a technique to improve INV patency both medially and laterally. This study analyzes the changes in minimal cross-sectional area (MCA) at the INV after graft placement and determines whether these changes are significantly different for normal versus narrow INVs.Noses of six fixed cadavers were dissected by open rhinoplasty to release the ULCs from the septum. Upper lateral strut grafts were placed through subperichondrial pockets along the ULC undersurfaces and out over the piriform apertures into subperiosteal pockets. Grafts were secured to the dorsal septum. Acoustic rhinometry and nasal endoscopy were used to classify INVs before graft placement as narrow or normal and to assess changes at the INV after graft placement.Mean pregraft MCA was 0.58 cm(2). Mean MCA percent increase after graft placement was 22%. By INV type, percent increases were 51% for narrow INVs and 1% for normal INVs. Mean increases in MCA after graft placement were statistically significant for the entire group and for narrow INVs, with increases of 0.10 cm(2) (p = 0.03) and 0.22 cm(2) (p = 0.004), respectively.The upper lateral strut graft improved patency of cadaveric INVs, with statistically significant increases in the MCA most notable when placed for narrow INVs.
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1101 Erie Blvd E Suite 200 Syracuse, NY 13210
750 E Adams St
100 Ostrom Ave
750 E. Adams St Upstate Medical University