# Next day sternal closure  can it be coded?



## TWilliam2019 (Feb 18, 2019)

2.13.19  PT HAD CABG  Ultimately the the heart demonstrated significant edema with its resting position being above the level of the posterior table of the sternum. With the somewhat unstable cardiac function it was necessary to abandon any attempt at sternal closure. 

2.14.2019  
Operations:
#1. Sternal plating with two  8-hole straight Biomet fixation plates (14 screws)
#2. Sternal wound closure
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Preoperative note: Patient is 72 y.o.-old  female postop day #1 CABG ×2 with significant post bypass cardiac edema and inability to perform chest closure. She has stable hemodynamics and is now being returned to the operating room for attempt to sternal wound closure.
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Operative findings:
#1. The pulmonary pressures were normal at 24/12. Upon removal of the Kerlix dressing artery edema was found to be significant only decreased.
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Description of operation: The patient was placed on the operating table in a supine position and adequate general anesthesia was administered monitoring the arterial pressure, pulmonary artery pressure, electrocardiogram, and oxygen saturation. The entire chest was prepped and draped in a sterile manner. The significant osteoporosis of the sternum. And there was separation of 2 rib insertions into the left lower sternum. The chest was thoroughly irrigated with antibiotic solution and with hemostasis the chest was closed in the following manner. #7 sternal wires were placed in the manubrium and the proximal body of the sternum. #7 wires were placed in the inferior aspect of the sternum. The sternal wires were then tightened and cut. The 2 Biomet straight fixation plates were then attached to the sternum and the corresponding ribs and fixated with #12 screws (a total of 14). His resulted in a very secure sternal closure. Further antibiotic irrigation was applied and then the wound was closed in layers. Sterile Dermabond  dressing was applied, sponge count was correct ×2 and the patient was taken back to the CVRU in stable condition.


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## victoriaholmes (Feb 19, 2019)

*Vicky Holmes, CIRCC,CCVTC*

yes, cpt 13160 78


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