bidler
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Patient had 4 procedures....What CPT codes should I use?
08/22/21
10/23/21
08/22/21
- Left frontal parietal 6” X 4” Craniotomy for evacuation of acute on chronic subdural hemorrhage.
- A J type incision
- Made with a 10” blade was completed with a bovie
- A single bur hole in parietal junction using matchstick drill
- The inner table was undermined using a #2 Kerrison
- A #2 Penfill was used to separate the inner table from the dura.
- Router used to perform a 6 x 4-inch cranial flap.
- The dura was tightly adhered to the bone flap the dura was removed but the balloon type cystic pseudomembranous formation was observed.
- The pseudomembranous was popped, and dark brownish motor oral type fluid along w/proteinaceous fluid was expressed.
- Using #1 penfield the distal portions of the frontal lobe were scraped. The scraping of the pseudomembranous formation of the natural dura scraped.
- Pathology samples were sent.
- At the end of the evacuation there was no obvious pseudo membranes noted and no obvious bleeding noted.
- Left frontal parietal 6 “ x 4” craniotomy for evacuation of acute subdural Hemorrhage.
- Head was draped staples removed
- The skin flap and the temporalis muscle were elected anteriorly and inferiorly, and retained using fish hooks the prior anchoring for millimeter titanium screws were removed from the plates and the bone flap was removed.
- A large hematoma was seen in the anterior aspect of the frontal lobe.
- The brain did re-expand to some degree compared to last surgery.
- The frontal region remains atrophied and shrunken.
- At the copiously irrigating the surrounding tissue use of the Dura was noted, without any obvious bleeding vessels. Floseal and patties were used to control the visible, reachable regions.
- After copious irrigation there was only a slight ooze of blood tinged irrigant.
- 10” French drain was placed.
- Duraplasty was then performed.
- The bone flap was then reapproximated and placed and secured using 5mm titanium screws.
- A subgaleal drain 10 French was then placed
- Galea was then closed using 2-0 vicryl sutures.
- The skin was closed using staples.
- Bactroban ointment, Telfa 4x4, fluffs, and Kerlix roll was used for the final dressing.
10/23/21
- Left Frontal bur hole craniotomy for evacuation of subdural empyema
- The old incision was still in the healing phase with scabs located in the inferior aspect, just posterior to the hex of the left ear.
- Using a #10 blade, a 1-inch incision was made over the scalp down to the skull bone.
- Wheatland retractors were used to maintain visual field.
- Using ate matchstick a small 10 mm bur hole was created.
- Entering past the inner table, mucous was seen expressing from the hole.
- 1st culture swab the mucus clung onto the swab and came out larger than expected.
- 2nd swab also done and had a similar large mucous collection.
- The epidural pocket was then irrigated with antibiotic solution.
- Duragen was seen beneath and picked up with a small instrument
- A 10-inch French drain was then placed into the subdural space.
- Space irrigated with antibiotic impregnated solution
- Drain attached to a JP bulb and compressed.
- Galea was then closed using 2-0 vicryl sutures.
- Skin was closed and stapled
- Left frontal bur hole craniotomy for tension pneumocephali
- Superior to the last burr hole to allow for blood flow to the scalp.
- A 14 mm incision was made w/ a#10 blade.
- A 7mm diameter burr hole was made with a match stick drill.
- The dura was seen and entered CSF was a little gray-ish at first, then infectious drainage was noted.
- 200 ml of irrigation was used to gently to wash the brain surface.
- Sediments was seen in the aspiration, eventually the wash was clear.
- A 10 French drain was placed into the wound via separate incision.
- Floseal was used to make the bur hole air tight.