TWilliam2019
Guru
Procedure(s):
LEFT GROIN EXPLORATION REMOVAL OF INFECTED GRAFT, WOUND VAC PLACEMENT
*
Procedure Date: 2/4/2019
*
Procedure list in detail:
1. Exploration of left femoral vessels with control of hemorrhage and evacuation of hematoma
2. Excision of infected left iliofemoral and portion of left femoral-popliteal grafts
3. Wound debridement and partial wound closure with placement of wound VAC
*
Pre-operative Diagnosis: * No Diagnosis Codes entered *
*
Post-operative Diagnosis: * No Diagnosis Codes entered *
*
Indications:
Acute hemorrhage with infected graft
Anesthesia Type: General
*
Findings:
Additional graft from artery separation with clinically infected unincorporated graft and probably infected native artery
*
Procedure Details:
This is an unfortunate patient with metastatic lung cancer and severe peripheral arterial disease who has had complications related to iliofemoral graft thrombosis, infected lymphocele and subsequent graft disruption presumably from an infection. She had a minor graft separation a couple days ago which was repaired with biologic pledgets.
*
She had done recently well for a couple days but developed brisk hemorrhage from the wound again today associated with hypotension and she was brought immediately to the operating room for exploration.
*
Exploration demonstrated further separation of the patient's graft from her native disease femoral artery around the previous site of repair. Clinically the graft is infected and likely accounts for further deterioration of the previous repairs as the area showed no significant healing from her surgery over a month ago.
*
Hemorrhage was rapidly controlled by placing a clamp on the iliofemoral portion of the graft. The graft following clamping rapidly thrombosed which at this point was okay because we did not intend to attempt further revascularization in this area. The graft was ligated above the inguinal ligament and allowed to retract into the retroperitoneum at this point. Graft was then completely removed from the femoral artery from which there was no backbleeding noted. Distal portion of the graft which consisted of a composite femoropopliteal graft was removed down to the mid thigh. Wound was irrigated and hemostasis ensured. The prior rotation flap was returned to its native donor position and the remainder of the wound left open for wound VAC application.
would 35903 be correct?
LEFT GROIN EXPLORATION REMOVAL OF INFECTED GRAFT, WOUND VAC PLACEMENT
*
Procedure Date: 2/4/2019
*
Procedure list in detail:
1. Exploration of left femoral vessels with control of hemorrhage and evacuation of hematoma
2. Excision of infected left iliofemoral and portion of left femoral-popliteal grafts
3. Wound debridement and partial wound closure with placement of wound VAC
*
Pre-operative Diagnosis: * No Diagnosis Codes entered *
*
Post-operative Diagnosis: * No Diagnosis Codes entered *
*
Indications:
Acute hemorrhage with infected graft
Anesthesia Type: General
*
Findings:
Additional graft from artery separation with clinically infected unincorporated graft and probably infected native artery
*
Procedure Details:
This is an unfortunate patient with metastatic lung cancer and severe peripheral arterial disease who has had complications related to iliofemoral graft thrombosis, infected lymphocele and subsequent graft disruption presumably from an infection. She had a minor graft separation a couple days ago which was repaired with biologic pledgets.
*
She had done recently well for a couple days but developed brisk hemorrhage from the wound again today associated with hypotension and she was brought immediately to the operating room for exploration.
*
Exploration demonstrated further separation of the patient's graft from her native disease femoral artery around the previous site of repair. Clinically the graft is infected and likely accounts for further deterioration of the previous repairs as the area showed no significant healing from her surgery over a month ago.
*
Hemorrhage was rapidly controlled by placing a clamp on the iliofemoral portion of the graft. The graft following clamping rapidly thrombosed which at this point was okay because we did not intend to attempt further revascularization in this area. The graft was ligated above the inguinal ligament and allowed to retract into the retroperitoneum at this point. Graft was then completely removed from the femoral artery from which there was no backbleeding noted. Distal portion of the graft which consisted of a composite femoropopliteal graft was removed down to the mid thigh. Wound was irrigated and hemostasis ensured. The prior rotation flap was returned to its native donor position and the remainder of the wound left open for wound VAC application.
would 35903 be correct?