AN2114
Guru
I would like an opinion on this report to see which code would be better to use. At first I was thinking code 64617 but since it doesn't mention the image guidance by needle electromyography in the report, I wasn't sure is 31571 would be better. Here is the report:
Procedure: Direct Laryngoscopy, and bronchoscopy with CO2 Laser, Right revision cordotomy and arytenoidecotmy, laryngeal balloon dilation, botox injection of cricothryoid muscle
Findings: CO2 laser excised the posterior right vocal cord and right arytenoid on a setting of 6 and 7 watt. Balloon dilation size#7 with the laryngeal balloon dilator at 17 mmHg. Botox injection of cricothyroid muscle with 9 units of botox under direct visualization.
Details: The patient was brought back to the OR and placed in the supine position. The patient was sedated by the anesthesia team. A critical timeout was performed and when everyone wa sin agreement, the procedure commenced. The patient was turned 90 degrees to the patient's right. The patient was draped in usual fashion. Using a laryngoscope and
fiberoptic hopkins rod telescope the supraglottic structures were identified. The scope was then passed through the glottic introitus into the subglottis and it was noted to be normal caliber. There proximal and distal trachea were normal. The carina was sharp and right and left mainstem bronchi were normal. The vocal cords were visualized to be in the more medial position, right posterior glottic wedge was noted but supraglottic tissue regrowth and redundant tissue did fill a portion of the previous surgical site. .
The Lindholm laryngoscope was then used to bring the larynx into view and suspended on the mayo stand. The head was wrapped with a wet towel. Everyone wore protective eyewear. The CO2 laser was calibrated and set at a setting of 6 watts. Laser excision first began at the right posterior vocal cord and excision continued out towards the right arytenoid. A medial cuff of the right arytenoid was left to avoid scarring. The laser was brought to 7 watts and the right arytenoid redundant tissue was excised. A cuff of right redundant arytenoid tissue regrowth was shelled out using the CO2 laser and the right posterior vocal cord was further excised until an adequate posterior opening was created, the true and false vocal cords were further removed in the right posteriorly. Eschar was removed with afrin-soaked pledgets. The 7 balloon was then advanced into the larynx and was situated at the glottis. This was inflated to 17 mmHg to dilate open the airway. Photodocumentation was taken before and after laser cordotomy
Instrumentation was removed and then the hopkins rod was used to identified the cricothyroid muscle. 9 units of botox was injected into the cricothyroid muscle. At this point, the procedure was completed and the patient was returned to anesthesia where he was woken up and brought to PACU in stable condition.
Procedure: Direct Laryngoscopy, and bronchoscopy with CO2 Laser, Right revision cordotomy and arytenoidecotmy, laryngeal balloon dilation, botox injection of cricothryoid muscle
Findings: CO2 laser excised the posterior right vocal cord and right arytenoid on a setting of 6 and 7 watt. Balloon dilation size#7 with the laryngeal balloon dilator at 17 mmHg. Botox injection of cricothyroid muscle with 9 units of botox under direct visualization.
Details: The patient was brought back to the OR and placed in the supine position. The patient was sedated by the anesthesia team. A critical timeout was performed and when everyone wa sin agreement, the procedure commenced. The patient was turned 90 degrees to the patient's right. The patient was draped in usual fashion. Using a laryngoscope and
fiberoptic hopkins rod telescope the supraglottic structures were identified. The scope was then passed through the glottic introitus into the subglottis and it was noted to be normal caliber. There proximal and distal trachea were normal. The carina was sharp and right and left mainstem bronchi were normal. The vocal cords were visualized to be in the more medial position, right posterior glottic wedge was noted but supraglottic tissue regrowth and redundant tissue did fill a portion of the previous surgical site. .
The Lindholm laryngoscope was then used to bring the larynx into view and suspended on the mayo stand. The head was wrapped with a wet towel. Everyone wore protective eyewear. The CO2 laser was calibrated and set at a setting of 6 watts. Laser excision first began at the right posterior vocal cord and excision continued out towards the right arytenoid. A medial cuff of the right arytenoid was left to avoid scarring. The laser was brought to 7 watts and the right arytenoid redundant tissue was excised. A cuff of right redundant arytenoid tissue regrowth was shelled out using the CO2 laser and the right posterior vocal cord was further excised until an adequate posterior opening was created, the true and false vocal cords were further removed in the right posteriorly. Eschar was removed with afrin-soaked pledgets. The 7 balloon was then advanced into the larynx and was situated at the glottis. This was inflated to 17 mmHg to dilate open the airway. Photodocumentation was taken before and after laser cordotomy
Instrumentation was removed and then the hopkins rod was used to identified the cricothyroid muscle. 9 units of botox was injected into the cricothyroid muscle. At this point, the procedure was completed and the patient was returned to anesthesia where he was woken up and brought to PACU in stable condition.