freespririt0806
Guru
Hi all
i am having trouble with neck dissection as i don't see he removed any lymph nodes
and not sure if it would be 2 codes or a combo code.
Dr states he did a total thyroidectomy with selective neck dissection
PROCEDURE IN DETAIL: The patient was brought to the operative suite. anesthesia induced rvithout difficulty. The
patient, procedure and laterality discussed and verified. This being done, the neck was slightly elavated , pt prepped and
draped and a horizontal incision made 2 fingerbreadths above the sternal notch extending laterally on the right side lor
the neck dissection. Subplatysmal flaps were raised superiorly and inferiorly-r-. The strap muscles were divided in the
midline. The thyroid isthmus was identified, clamped, cut, and tied. Beginning on the left. dissection superiorly rvas
performed to identi$ the superior thyroid artery and vein which were clamped, cut, and tied; laterally, the thl,roid veut
was identified, clamped, cut and tied; and inferiorly, the thyroid artery and vein were clamped cut, and tied.
Dissection on the inferior lobe was performed. The para thyroid gland was identified and left intact -the recurrent laryngeal nerve
identified and dissection to the cricothyrioid joint was performed detaching gland from the trachea.
This being done, the remainder of the the gland was dissected free and passed off the table. The wound was irrigated with
normal saline. This was repeated on the right side
However, the gland was sticky laterally. I was able to come
through the thyroid vein, but the tissue was adherent to the lateral gland. Once the thyroid was removed. this tissue was dissected free
coming along the deep s cervical fascia laterally to the carotid sheath then the carotid sheath
rwas peeled away from the specimen. Superiorly, it was taken to the hyoid and transected. The strap muscle's were
elevated laterally to the SCM and this dissection plane was taken deep to the carotid sheath. Finally, inferiorly' it was
taken down to the omohyoid where all soft tissue was clamped, cut and tied and this block of tissue was passed off table. the remaining neck was palpated bilaterally for enlarged lymph notes and none were seen
i am having trouble with neck dissection as i don't see he removed any lymph nodes
and not sure if it would be 2 codes or a combo code.
Dr states he did a total thyroidectomy with selective neck dissection
PROCEDURE IN DETAIL: The patient was brought to the operative suite. anesthesia induced rvithout difficulty. The
patient, procedure and laterality discussed and verified. This being done, the neck was slightly elavated , pt prepped and
draped and a horizontal incision made 2 fingerbreadths above the sternal notch extending laterally on the right side lor
the neck dissection. Subplatysmal flaps were raised superiorly and inferiorly-r-. The strap muscles were divided in the
midline. The thyroid isthmus was identified, clamped, cut, and tied. Beginning on the left. dissection superiorly rvas
performed to identi$ the superior thyroid artery and vein which were clamped, cut, and tied; laterally, the thl,roid veut
was identified, clamped, cut and tied; and inferiorly, the thyroid artery and vein were clamped cut, and tied.
Dissection on the inferior lobe was performed. The para thyroid gland was identified and left intact -the recurrent laryngeal nerve
identified and dissection to the cricothyrioid joint was performed detaching gland from the trachea.
This being done, the remainder of the the gland was dissected free and passed off the table. The wound was irrigated with
normal saline. This was repeated on the right side
However, the gland was sticky laterally. I was able to come
through the thyroid vein, but the tissue was adherent to the lateral gland. Once the thyroid was removed. this tissue was dissected free
coming along the deep s cervical fascia laterally to the carotid sheath then the carotid sheath
rwas peeled away from the specimen. Superiorly, it was taken to the hyoid and transected. The strap muscle's were
elevated laterally to the SCM and this dissection plane was taken deep to the carotid sheath. Finally, inferiorly' it was
taken down to the omohyoid where all soft tissue was clamped, cut and tied and this block of tissue was passed off table. the remaining neck was palpated bilaterally for enlarged lymph notes and none were seen