# Closed Thoracotomy



## BUDDY1983 (Oct 21, 2010)

How would you code a Closed Thoracotomy (Provider states closed Thoracotomy) sounds like 32551.

Going in at about what I think will be the 6th interspace laterally, about the level of the center of her breast in about the mid axillary line, I infiltrated 1% lidocaine with epinephrine as described above and in order to adequately insert the tube and palpate her ribs, I had to make an incision long enough so that it met my palpating finger, namely 2.5 to 3 cm in length.  Dissection was carried down through the subcutaneous tissue, further anesthetic infiltrated and, by blunt dissection with a hemostat, I was able to reach the underlying fascia.  I was then able to palpate some of the ribs for the first time and a scalpel was used to incise the fascia above one of the ________ underlying Kelly clamp was used to stretch things open and finally, after much palpation and being able to put my finger in place to be sure exactly where we were, which is essential I believe in doing a closed thoracotomy in someone her size, I finally was able to go over her rib and enter the thoracic cavity.  Serosanguineous fluid came out under pressure.

A chest tube, a #28 French straight tube, was then advanced into the area.  Again, I was able to palpate as the tube went through the ribs to be sure it was in proper position and I was then able also to palpate in the tube the last hole and to assure it was just beneath the ribs and in the pleural cavity as best I could tell.  Pleural tube was then connected to the Pleurovac suction device and allowed to drain.  The tube did indeed appear to be positioned properly as we carefully held it in place.


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