# Neck exploration & drainage.....



## ksb0211 (Mar 22, 2011)

Not quite sure if I need to just use an unlisted code (always a last resort, of course).  Hoping for some input.

PROCEDURE/OPERATION
Right neck exploration and drainage.

ANESTHESIA
General.

INDICATION
This patient had ingested a chicken bone.  The bone was lodged approximately 17 to 18 centimeters from the incisors.  It was extremely sharp.  Multiple attempts at removal including flexible esophagogastroduodenoscopy, direct vision, attempt at straight esophagoscopy were all unsuccessful.  Ultimately, the bone was removed but it resulted in a tear in the proximal cervical esophagus.  This was visualized.  On finding this result, the patient was immediately given intravenous broad-spectrum antibiotics and prepared for surgery.

DESCRIPTION OF PROCEDURE
The patient was prepped with DuraPrep and draped sterilely.  The rent appeared to be to the right of midline.  The patient had significant crepitus, more right than left.  An incision was made anterior to the sternocleidomastoid muscle on the right side and carried down through the subcutaneous tissues.  Crepitus was appreciated at that level.  The sternocleidomastoid muscle was then retracted laterally.  The thyroid strap muscles were retracted and the thyroid gland exposed.  This was then retracted medially and dissection next to the trachea and ultimately to the esophagus on the right side and then posteriorly was performed utilizing primarily sharp dissection.  Once the planes had been well-developed, it was clear there was no obvious rent that could be sutured from this access.  A 10 millimeter Jackson-Pratt drain was then placed.  It was brought through a separate stab incision.  The tissue was then loosely closed with 2-0 Vicryl to the deep tissue and then 4-0 nylon vertical mattress sutures to the skin.  


Not quite sure where to go from here.  Help, please?~?~  :-D


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## surgonc87 (Mar 23, 2011)

The intent was for an esophagoplasty...After dissection, it was found that there was not a tear... You can code 43300 with mod 52, or the unlisted code and mock with reduction of the fee for 43300.

That's how I would personally approach it

MS


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