# Gunshot Wound to the Chest



## tabbsmith (Nov 2, 2011)

The dr's perform 3 separate procedures but I am stuck on coding one of them.  Here is the Op Report:

The peritoneal cavity was entered without difficulty and the abdomen was noted to be without evidence of injury or defect.  No blood was identified.  The chest was then re-evaluated and the patient began to deteriorate, at which time bilater chest tubes were placed on right and left sides.  This improved his hemodynamic performance and a medican sternotomy was quickly performed initially with a scapel to the skin overlying the sternum then with the electrocautery and sternal saw.  Ther sternal edges were treated with bone was, and the chest wall retractor placed in the sternum to allow for exposure of the underlying organs.  The pericardial sac was identified and incised, a large amount of approximately 400ml of clot were identified and removed.  A large laceration was noted to the anterior aspect of the right ventricle near the apex just to the right of the left anterior descending.  Pressure was held over this while anesthesia kept up with volume. Heart was beating poorly.  but reponded to epinephrine.
No posterior injury to the heart or through-and-through injury was identified.  No bullet was palpable in the apex of the heart or the intraventricular septum.  Blood pressure was maintained by holding pressure overlying the right vetricular injury and this was quickly using a figure-of-eight stitch which allowed for some hemorrhage control. No furhter blood well up from the sternum and the subcuticular tissued with the eclectrocautery.
Quick exploration of the abdomen revealed no evidence of intra-abdominal injury.

Here are the codes that I have for the Sternotomy 21627
                                                      Laceration of Heart  -- need cpt code
                                                       Exploratory of Abdomen 49000

Please let me know if I am right with the other two codes

I really appreciate someone to help me with this missing or incorrect codes.

Thanks


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## hmfarrell (Nov 3, 2011)

33300, Repair of cardiac wound, without bypass


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## tabbsmith (Nov 4, 2011)

Thanks for your help with the coding.


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## FTessaBartels (Nov 4, 2011)

*Sternotomy is global*

The sternotomy cannot be separately coded; it is integral to the repair of the cardiac wound. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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