jk2003
Networker
Hello, one of our physicians is billing for surgical preparation of scalp wound 3.5x10cm2, adjacent tissue transfer tissue transfer of scalp 32 cm2, and placement of Alloderm to scalp 4x8cm: 15335, 14021, 15004. Please see below OP Note:
INDICATIONS FOR PROCEDURE:
The patient is a 70-year-old woman who had previous hardware placed to the right postauricular area secondary to aneurysm treatment. The hardware is now exposed. It is now indicated at this time that the patient undergo revision cranioplasty with wound closure. The risks, benefits, complications and possible consequences of the procedure were discussed with the patient's family. The patient's family had an opportunity to ask questions. All questions were answered and informed consent was obtained.
PROCEDURE:
The patient was identified in the preoperative holding area of the X-Medical Center third floor main operative suite and brought to the operating room and placed supine on the table. After general endotracheal anesthesia was achieved, the neurosurgical service sterilely prepped and draped the patient. Please see Dr. X's separately dictated operative report for details.
A revision cranioplasty was then performed by Dr. X with removal of additional hardware; please see Dr. X's separately dictated operative report.
After this was done, the wound was evaluated. The wound was noted to be 3.5 x 10 cm in diameter with exposed bone. Additional debridement of the wound was then performed using sharp scissors and electrocautery. After this was done, Tisseal, which was reconstituted according to manufacturer's specifications, was placed for additional hemostasis, which was noted to be good. A 4 x 12 piece of thick implantable AlloDerm was then reconstituted according to manufacturer's specifications and then trimmed to 4 x 8 cm square and inset using multiple 2-0 Vicryl sutures to suture the AlloDerm overlying the bone.
After this was completed, the trapezius muscle which was located within the wound was then dissected free for a total of 4 x 8 cm and then rotated and inset into the surgical site and secured using multiple 2-0 Vicryl sutures. A #7 round Jackson-Pratt drain was then placed and brought out through the inferior portion of the incision to bulb suction and secured using a 2-0 silk suture.
Multiple Z-plasties were then performed of the skin in order to close the superior portion of the defect. Z-plasties were secured using 2-0 Polysorb suture and 3-0 nylon suture in an interrupted fashion. After this was completed, the defect was noted to be completely closed. Indermil was applied, Steri-Strips applied.
The patient tolerated the procedure well. There were no complications. The patient was subsequently extubated and brought to the recovery room awake and in stable condition. Postoperative plan is to admit the patient for continued post surgical monitoring. Dr. X was present and performed his entire portion of the procedure.
We thought the Alloderm and flap was billable, but heard otherwise. Could someone confirm.
Thanks in advance.
INDICATIONS FOR PROCEDURE:
The patient is a 70-year-old woman who had previous hardware placed to the right postauricular area secondary to aneurysm treatment. The hardware is now exposed. It is now indicated at this time that the patient undergo revision cranioplasty with wound closure. The risks, benefits, complications and possible consequences of the procedure were discussed with the patient's family. The patient's family had an opportunity to ask questions. All questions were answered and informed consent was obtained.
PROCEDURE:
The patient was identified in the preoperative holding area of the X-Medical Center third floor main operative suite and brought to the operating room and placed supine on the table. After general endotracheal anesthesia was achieved, the neurosurgical service sterilely prepped and draped the patient. Please see Dr. X's separately dictated operative report for details.
A revision cranioplasty was then performed by Dr. X with removal of additional hardware; please see Dr. X's separately dictated operative report.
After this was done, the wound was evaluated. The wound was noted to be 3.5 x 10 cm in diameter with exposed bone. Additional debridement of the wound was then performed using sharp scissors and electrocautery. After this was done, Tisseal, which was reconstituted according to manufacturer's specifications, was placed for additional hemostasis, which was noted to be good. A 4 x 12 piece of thick implantable AlloDerm was then reconstituted according to manufacturer's specifications and then trimmed to 4 x 8 cm square and inset using multiple 2-0 Vicryl sutures to suture the AlloDerm overlying the bone.
After this was completed, the trapezius muscle which was located within the wound was then dissected free for a total of 4 x 8 cm and then rotated and inset into the surgical site and secured using multiple 2-0 Vicryl sutures. A #7 round Jackson-Pratt drain was then placed and brought out through the inferior portion of the incision to bulb suction and secured using a 2-0 silk suture.
Multiple Z-plasties were then performed of the skin in order to close the superior portion of the defect. Z-plasties were secured using 2-0 Polysorb suture and 3-0 nylon suture in an interrupted fashion. After this was completed, the defect was noted to be completely closed. Indermil was applied, Steri-Strips applied.
The patient tolerated the procedure well. There were no complications. The patient was subsequently extubated and brought to the recovery room awake and in stable condition. Postoperative plan is to admit the patient for continued post surgical monitoring. Dr. X was present and performed his entire portion of the procedure.
We thought the Alloderm and flap was billable, but heard otherwise. Could someone confirm.
Thanks in advance.
