SHARON1221
New
Can exposure of great vessels be billed when an Excision of neurofibroma or neurolemmoma; major peripheral nerve was performed?
Patient was brought to the operating room placed supine operating room table. After general endotracheal anesthesia was obtained the patient was prepped and draped in a sterile fashion. I added as a co-surgeon during this operation for exposure of these nerve tissue mass that was intimately associated with the right subclavian artery, axillary artery, subclavian vein, axillary vein and brachial plexus. We began by making a transverse incision just below the clavicle. Dissection down to subcutaneous tissues and incised the pectoralis major. We continued our dissection down through the infraclavicular fossa through the fat pad and identified the axillary vein and axillary artery. We also identified the brachial plexus which in which care was provided to keep this a from injury. We realized the mass extended further medial and underneath the clavicle. We then continued our dissection laterally to the subclavian vessels. The vessels were intimately associated with this mass and I was able to dissect this free using a combination of sharp dissection as well as electrocautery. Multiple venous and arterial branches had to be tied off with 3-0 silk ties. We then were able to obtain good exposure to the mass itself retracting the subclavian vessels inferiorly and the brachial plexus inferiorly and laterally. At this point Dr. Singh identified the large mass which he was able to dissect out by enucleation of the mass. This will be dictated separately in his operative note. The mass was taken out in its entirety and I examined the wound for any further bleeding. The wound was hemostatic and washed out closely with bacitracin irrigation. It was then closed in multiple layers.
my code selection is 64790, but what about the exposure? 35761 ?
Thanks for any help!
Patient was brought to the operating room placed supine operating room table. After general endotracheal anesthesia was obtained the patient was prepped and draped in a sterile fashion. I added as a co-surgeon during this operation for exposure of these nerve tissue mass that was intimately associated with the right subclavian artery, axillary artery, subclavian vein, axillary vein and brachial plexus. We began by making a transverse incision just below the clavicle. Dissection down to subcutaneous tissues and incised the pectoralis major. We continued our dissection down through the infraclavicular fossa through the fat pad and identified the axillary vein and axillary artery. We also identified the brachial plexus which in which care was provided to keep this a from injury. We realized the mass extended further medial and underneath the clavicle. We then continued our dissection laterally to the subclavian vessels. The vessels were intimately associated with this mass and I was able to dissect this free using a combination of sharp dissection as well as electrocautery. Multiple venous and arterial branches had to be tied off with 3-0 silk ties. We then were able to obtain good exposure to the mass itself retracting the subclavian vessels inferiorly and the brachial plexus inferiorly and laterally. At this point Dr. Singh identified the large mass which he was able to dissect out by enucleation of the mass. This will be dictated separately in his operative note. The mass was taken out in its entirety and I examined the wound for any further bleeding. The wound was hemostatic and washed out closely with bacitracin irrigation. It was then closed in multiple layers.
my code selection is 64790, but what about the exposure? 35761 ?
Thanks for any help!