Would someone please help me code this procedure from our Neuro IR MD.
PROCEDURE IN DETAIL: Informed consent was obtained from the patient and his wife after explaining the procedure, it's rationale and risks (infection, bleeding, contrast allergy, nerve injury, headache, skin injury/breakdown, etc.). The patient and his wife expressed an understanding of the procedure and it's risks as well as a willingness to undergo the procedure.
The patient was placed on the angiographic table in supine position. The patient's left side of the face was prepped and draped in the usual sterile fashion. A standard time-out procedure was performed. Using sterile technique, local anesthesia, MAC anesthesia, ultrasound and fluoroscopic guidance, a 21-gauge micropuncture needle was advanced into the cystic collection, superficial to the left submandibular gland, and extending around the left mandibular ramus.
Injection of contrast material was performed, demonstrating that this was one multilobulated cyst, with free communication between the lobules.
In trying to aspirate contents from this lesion, it was noted that the material was extremely viscus, clear and tenacious. Only a small amount could be aspirated through the 21-gauge needle.
Subsequently, the doxycycline was injected into the lesion, 2 separate times for a total of 7 cc. The doxycycline was allowed to stay in during the entirety of the procedure and was not drained at the end.
At the termination of the procedure the needle was removed and band-aids were placed over the skin puncture site(s). The patient tolerated the procedure well and no complications were encountered during or immediately following the procedure.
FINDINGS: The fluid within the cyst was noted to be extremely viscous, clear and tenacious, suggesting high protein content. The appearance overall was not consistent or typical of lymphatic fluid. This may be more compatible with a sialocele
IMPRESSION:
1. The cystic lesion is a multilobulated single compartment cyst. The material within was extremely thick, viscous and tenacious and relatively clear in appearance. This is atypical for lymphatic fluid and may suggest rather a sialocele.
2. Due to the extreme viscosity, only a small amount could be aspirated which was not adequate for amylase testing after it was sent to the lab.
3. The cavity was treated with doxycycline in order to achieve sclerosis of the cavity and hopefully a decrease in the size of the lesion.
I could not find an appropriate CPT code for sclerosing of a mandibular cyst.
Thank you,
Liza
PROCEDURE IN DETAIL: Informed consent was obtained from the patient and his wife after explaining the procedure, it's rationale and risks (infection, bleeding, contrast allergy, nerve injury, headache, skin injury/breakdown, etc.). The patient and his wife expressed an understanding of the procedure and it's risks as well as a willingness to undergo the procedure.
The patient was placed on the angiographic table in supine position. The patient's left side of the face was prepped and draped in the usual sterile fashion. A standard time-out procedure was performed. Using sterile technique, local anesthesia, MAC anesthesia, ultrasound and fluoroscopic guidance, a 21-gauge micropuncture needle was advanced into the cystic collection, superficial to the left submandibular gland, and extending around the left mandibular ramus.
Injection of contrast material was performed, demonstrating that this was one multilobulated cyst, with free communication between the lobules.
In trying to aspirate contents from this lesion, it was noted that the material was extremely viscus, clear and tenacious. Only a small amount could be aspirated through the 21-gauge needle.
Subsequently, the doxycycline was injected into the lesion, 2 separate times for a total of 7 cc. The doxycycline was allowed to stay in during the entirety of the procedure and was not drained at the end.
At the termination of the procedure the needle was removed and band-aids were placed over the skin puncture site(s). The patient tolerated the procedure well and no complications were encountered during or immediately following the procedure.
FINDINGS: The fluid within the cyst was noted to be extremely viscous, clear and tenacious, suggesting high protein content. The appearance overall was not consistent or typical of lymphatic fluid. This may be more compatible with a sialocele
IMPRESSION:
1. The cystic lesion is a multilobulated single compartment cyst. The material within was extremely thick, viscous and tenacious and relatively clear in appearance. This is atypical for lymphatic fluid and may suggest rather a sialocele.
2. Due to the extreme viscosity, only a small amount could be aspirated which was not adequate for amylase testing after it was sent to the lab.
3. The cavity was treated with doxycycline in order to achieve sclerosis of the cavity and hopefully a decrease in the size of the lesion.
I could not find an appropriate CPT code for sclerosing of a mandibular cyst.
Thank you,
Liza