Would I bill for both the drainage of the hydrocele and the orchiectomy or just the orchiectomy? Thanks!!
PROCEDURES PERFORMED: 1. Left scrotal hydrocelectomy and then
aborted followed by.
2. Left inguinal orchiectomy.
ANESTHESIA: General.
DETAILS OF PROCEDURE: This 47-year-old who was referred to us for evaluation of the
above-mentioned the troubles. On physical exam, his left hemiscrotum was extremely tight but not
uncommon for a hydrocele, and no point preoperatively, I was able to palpate the left testicle. Because of
his age and because of his history and the work that he does, I felt that the clinical indication here was
standard scrotal approach to what we felt like a standard left scrotal hydrocele. He received appropriate
preoperative antibiotics in the holding area, was taken to the operating room, given a general anesthetic. A
time-out was taken for identification purposes. He was then placed in a slightly hyperextended supine
position, given an appropriate shave prep and scrub prep, and then a midline scrotal incision was made
carried down toward the left-hand side and the tunics were then peeled off of the scrotal skin in a
standard fashion as though doing a hydrocele. This was rather adhesed however, and I felt that an
inflammatory process might have been partly responsible for what we were dealing with. Finally, we had
enough of the tunica vaginalis exposed that we are able to deliver that up into the wound and then opened
and drained it and about 300 cc of clear fluid was obtained. However, at this point that it is become quite
obvious that there was something terribly wrong with this left testicle. It was nodular. It was extremely
hard and even into the epididymis on the left-hand side. I am not sure if this was strictly inflammatory or
not but it any event, I called my partner Dr. C*****l into take a look of course, we can be wrong but I
believe that this is a malignant process. If not, it is a severe inflammatory process and in any event, I think
it was appropriate to simply remove the testicle as that was part of our preop briefing. So, the cord was
bifurcated and then cut at the level of the external ring and not more standard left inguinal exploration with
a high excision of the cord, then the entire testicle and epididymis, etc. were submitted for pathologic
analysis. Hemostasis within the scrotal cavity was seen to be reasonable. So, the cord was allowed to
retract to its normal anatomic position having been both stick tied and freehand tied on both portions of the
cord. The cord was also anesthetized with some Marcaine and additional Marcaine was simply placed
into the left hemiscrotum for his immediate postoperative comfort. The dartos was whipstitched close
with a running 2-0 locking one utilizing 2-0 Vicryl ligature and the skin was closed subcuticularly using a
4-0 Vicryl ligature. SS 20211220
PROCEDURES PERFORMED: 1. Left scrotal hydrocelectomy and then
aborted followed by.
2. Left inguinal orchiectomy.
ANESTHESIA: General.
DETAILS OF PROCEDURE: This 47-year-old who was referred to us for evaluation of the
above-mentioned the troubles. On physical exam, his left hemiscrotum was extremely tight but not
uncommon for a hydrocele, and no point preoperatively, I was able to palpate the left testicle. Because of
his age and because of his history and the work that he does, I felt that the clinical indication here was
standard scrotal approach to what we felt like a standard left scrotal hydrocele. He received appropriate
preoperative antibiotics in the holding area, was taken to the operating room, given a general anesthetic. A
time-out was taken for identification purposes. He was then placed in a slightly hyperextended supine
position, given an appropriate shave prep and scrub prep, and then a midline scrotal incision was made
carried down toward the left-hand side and the tunics were then peeled off of the scrotal skin in a
standard fashion as though doing a hydrocele. This was rather adhesed however, and I felt that an
inflammatory process might have been partly responsible for what we were dealing with. Finally, we had
enough of the tunica vaginalis exposed that we are able to deliver that up into the wound and then opened
and drained it and about 300 cc of clear fluid was obtained. However, at this point that it is become quite
obvious that there was something terribly wrong with this left testicle. It was nodular. It was extremely
hard and even into the epididymis on the left-hand side. I am not sure if this was strictly inflammatory or
not but it any event, I called my partner Dr. C*****l into take a look of course, we can be wrong but I
believe that this is a malignant process. If not, it is a severe inflammatory process and in any event, I think
it was appropriate to simply remove the testicle as that was part of our preop briefing. So, the cord was
bifurcated and then cut at the level of the external ring and not more standard left inguinal exploration with
a high excision of the cord, then the entire testicle and epididymis, etc. were submitted for pathologic
analysis. Hemostasis within the scrotal cavity was seen to be reasonable. So, the cord was allowed to
retract to its normal anatomic position having been both stick tied and freehand tied on both portions of the
cord. The cord was also anesthetized with some Marcaine and additional Marcaine was simply placed
into the left hemiscrotum for his immediate postoperative comfort. The dartos was whipstitched close
with a running 2-0 locking one utilizing 2-0 Vicryl ligature and the skin was closed subcuticularly using a
4-0 Vicryl ligature. SS 20211220