# Need HELP!! - Dedo laryngoscope



## tosborne (Nov 7, 2012)

Here is the OP report:

Preoperative diagnosis: Left neck mass and right vocal cord lesion
Post operative diagnosis: Left neck mass and right vocal cord lesion

Procedures: 1.Suspension microlaryngoscopy with right vocal cord stripping
2. Direct laryngoscopy with multiple biopsies.
3. Excision of left neck mass.

Procedure in detail:
After the patient was properly identified and placed under general endotracheal anesthesia in the supine position, the larynx was suspending with a Dedo laryngoscope and evaluated wtih fiberoptic lens system and monitor. The left voacal cord appeard to be normal. The right vocal cord was edematous with some erythema and patches of leukoplakia. The right vocal cord was stripped in its entirety. At this poing, the telescope was removed and a direct laryngoscopy was performed with a Dedo laryngoscope with multiple bipsies obtained at left and right base of tongue, left and right tonsil fossae, and the nasopharynx. Upon direct laryngoscopy and examination, there appeared to be no obvious lesions in the vallecula, piriform sinus, postcricoid area, supraglottic larynx, or nasopharyne. At this point, the patient was prepped and draped for left neck surgery. The left neck mass was identified and the overlying sckin was injected with 1 lidocaine wiht 100,000 epinephrine. A transverse incision was made in the skine crease and taken through the skin, subcutateous, and platysmal layers. Small superior and inferior flaps were then elevated. In this area, smooth, mobile lymph node was identified overlying the jugular vein. Using sharp and blunt dissection, it was removed with hemostasis acheived by direct compression and electrocautery. The node was then submitted in its entirey for pathologic evaluation. Additional hemostasis was achieved with spot electrocautery. The wound was then irrigated. The playsmal layer was closed with interrupted 4-0 Vicryl Subcutaneous tissue and skin were closed with a continuous subcuticular closure of 4-0 chromic. Steri-strips were applied and a dressing also placed. At this point, the procedure was complete. The patient was taken to recovery in good condition.

I think that codes 31541, 31510m and 38510 should be billed. My co-worker thinks that codes 31535, 31536, and 38510 should be billed. Can someone please give their opinion and guidance!! Thanks.


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