# 7,8,9 intercostal neurectomies and rib resection



## shanhockyfan (Jun 15, 2011)

Ok, I have spent over an hour trying to find any codes that will cover the neurectomies. Here is the OP note:
"I injected the skin with 0.5% ropivacaine plain and made an incision right in the area of the previous incision from the rib resection. I dissected through the dermis and subq fat until i identified the trapezius and latissimus muscles. I retracted these out of the way and continued dissecting through the fascial layers until i identified the intercostal muscles. I identified the 7th, 8th and 9th ribs and began working on the 7th rib by dividing the intercostal muscle attachments to the inferior portion of the rib. i identified immediately the neurovascular bundle. i clampled this proximally and distally and then removed about 1 cm of the neurovascular bundle. i ligated both ends w/ 2-0 silk suture. Same procedure for the 9th rib. Because of the prior surgery, after dividing the intercostal muscles from the 8th rib, i was unable to clearly identify a neurovascular bundle. i sent off some tissue to determine if nerve was present in it, but nothing that i could clearly confidently say that was a neurovascualr bundle. I removed 2 cm of the rib so that i could better inspect the area around the rib, but still could not find a neurovascualr bundle." 

My provider then closed w/ no problems. i just have NO idea where to find the excision of the nerve bundles!!!

Any help would be very helpful in my finding my way through this surgery. Thanks


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