daniel
True Blue
How do you see this part Cortical craniectomy/debridement of cortical skull bone?
So far I have the following, but stuck on this Craniecotmy… OR SHOULD THE Whole case be 61500?
21014- Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intramuscular); 2 cm or greater (I like this code)
15275- Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area
Operation Performed:
1. Cortical craniectomy/debridement of cortical skull bone
2. Wide local excision scalp tumor 10 cm x 10 cm-
3. Placement of Integra 8 cm x 8 cm
Findings Details:
1. 8cm x 8cm exophytic vertex scalp tumor involving underlying bone
2. Multiple actinic keratoses surrounding tumor
Procedure Details:
The patient was brought to surgery, placed on the table in supine position, and placed under general anesthesia via endotracheal intubation. After adequate anesthesia was achieved, the patient was turned 180 degrees from Anesthesia. A time out was performed. The surgical site was infiltrated with 2% lidocaine w/epinephrine (10mL), then prepped and draped in the sterile fashion. An incision was made down to the subgaleal layer with a #10 scalpel around the tumor. A bovie was used to sharply dissect the tumor from the pericranium. Deep to the tumor, the pericranium was taken with the specimen. Tumor involved the underlying bone in the center of the main tumor. The specimen was oriented and passed off the field. Cutaneous margins were taken circumferentially, as well as a pericranium margin posteriorly.
At this time, we noted that patient's pulse oximeter displayed decreasing oxygenation. The Anesthesia attending entered the room, the patient was flattened from sitting position, and we attempted to palpate a pulse. Patient exhibited perioral and intraoral paleness and it was very difficult to palpate a pulse. Therefore the code cart was called for and compressions were started. Anesthesia asked us to stop after a few seconds as vital signs began to normalize. Arterial line was placed and more accurate heart rate/blood pressure was obtained. The patient regained color, and we resumed surgery at the guidance of Anesthesia.
The involved bone was drilled with a 6 cutting burr 4-5mm. The remaining exposed bone was drilled a few mm down to some bleeding. The surrounding tissue was undermined and the wound was cerclaged using an 0 vicryl. Integra was trimmed to cover the wound and sutured in place using 3-0 chromic suture. A bolster was secured overlying using Xeroform gauze and Allevyn dressing.
The care of the patient was then returned to the anesthesiologist. The patient was awakened, extubated, and taken to the recovery room in his preoperative condition.
Rapid Frozen Section Telephone Findings:
Negative margins on RFS
Specimens Removed: as above
So far I have the following, but stuck on this Craniecotmy… OR SHOULD THE Whole case be 61500?
21014- Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intramuscular); 2 cm or greater (I like this code)
15275- Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area
Operation Performed:
1. Cortical craniectomy/debridement of cortical skull bone
2. Wide local excision scalp tumor 10 cm x 10 cm-
3. Placement of Integra 8 cm x 8 cm
Findings Details:
1. 8cm x 8cm exophytic vertex scalp tumor involving underlying bone
2. Multiple actinic keratoses surrounding tumor
Procedure Details:
The patient was brought to surgery, placed on the table in supine position, and placed under general anesthesia via endotracheal intubation. After adequate anesthesia was achieved, the patient was turned 180 degrees from Anesthesia. A time out was performed. The surgical site was infiltrated with 2% lidocaine w/epinephrine (10mL), then prepped and draped in the sterile fashion. An incision was made down to the subgaleal layer with a #10 scalpel around the tumor. A bovie was used to sharply dissect the tumor from the pericranium. Deep to the tumor, the pericranium was taken with the specimen. Tumor involved the underlying bone in the center of the main tumor. The specimen was oriented and passed off the field. Cutaneous margins were taken circumferentially, as well as a pericranium margin posteriorly.
At this time, we noted that patient's pulse oximeter displayed decreasing oxygenation. The Anesthesia attending entered the room, the patient was flattened from sitting position, and we attempted to palpate a pulse. Patient exhibited perioral and intraoral paleness and it was very difficult to palpate a pulse. Therefore the code cart was called for and compressions were started. Anesthesia asked us to stop after a few seconds as vital signs began to normalize. Arterial line was placed and more accurate heart rate/blood pressure was obtained. The patient regained color, and we resumed surgery at the guidance of Anesthesia.
The involved bone was drilled with a 6 cutting burr 4-5mm. The remaining exposed bone was drilled a few mm down to some bleeding. The surrounding tissue was undermined and the wound was cerclaged using an 0 vicryl. Integra was trimmed to cover the wound and sutured in place using 3-0 chromic suture. A bolster was secured overlying using Xeroform gauze and Allevyn dressing.
The care of the patient was then returned to the anesthesiologist. The patient was awakened, extubated, and taken to the recovery room in his preoperative condition.
Rapid Frozen Section Telephone Findings:
| ID | ||||||
| A : Scalp Mass | ||||||
| B : 9-12 o clock margin | ||||||
| C : 12-3 o clock margin | ||||||
| D : 3-6 o clock margin | ||||||
| E : 6-9 o clock margin | ||||||
| F : posterior pericranial margin |
Specimens Removed: as above