# Removal chest wall nodule- ribs not incl



## Coder708 (Mar 9, 2010)

SO I was in the 19271 area and they all include ribs.. ANy coding help

PREOPERATIVE DIAGNOSIS:
Left chest wall subcutaneous nodules, nodular pleural thickening of left
chest, rule out mesothelioma versus other carcinoma.
POSTOPERATIVE DIAGNOSES:
Poorly differentiated carcinoma.
PROCEDURE:
Excision of left chest wall nodule.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room and placed supine on the
operating table.  The procedure was done with conscious sedation and
local analgesia.  The patient was positioned supine on the operating
table.  His left arm was abducted at the shoulder on an arm board.  His
left axilla and chest wall were prepped and draped in the usual sterile
fashion.  The patient had a mobile palpable subcutaneous nodule overlying
the fourth intercostal space in the mid axillary line.  Prior to making a
skin incision with a 15-blade, 7 mL of 0.5% MARCAINE without EPINEPHRINE
were instilled into the subcutaneous tissues and the tissues surrounding
the nodule.  A skin incision was made and electrocautery was used to
dissect down through subcutaneous tissues.  Blunt dissection was used to
help mobilize the nodule from surrounding tissues.  A small lymph versus
small vascular structure was tied off with Vicryl ties.  The nodule was
excised and sent for frozen section analysis.  After achieving complete
hemostasis, 2-0 Vicryl was used in an interrupted inverted fashion to
reapproximate the Scarpas fascia.  A 4-0 Monocryl was used to close the
skin.  Mastisol and Steri-Strips were applied, followed by dry sterile
dressing.  The frozen section analysis revealed poorly differentiated
carcinoma.


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## mjewett (Mar 9, 2010)

Code 21555 or 21552, depending on the size should do the trick.


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## Coder708 (Mar 9, 2010)

PERFECT.. wonderful. Thank you so much Melissa


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