txdel
New
Can some one guide me in the right direction on this Op report. I was thinking 21014 for the scalp and 21556 for the chest but it seems that the dr did not remove the entire mass. also is the 1573 series correct for the flap?
OPERATION PERFORMED:
1. Excision of occipital parietal scalp with vascularized scalp flap reconstruction.
2. Incisional biopsy, right paramedian chest.
Work was begun at the anterior chest. A 4 cm horizontal incision was made over the dome of this fixed mass over the anterior chest. Dissection was carried through skin and subcutaneous tissue, and underlying portions of the pectoralis to expose an encapsulated tumor affixed to ribs, a 1 x 2 cm ellipse from the tumor was harvested for diagnosis. Bleeding was controlled with cautery. Closure was with interrupted 3-0 Vicryl, interrupted and running 4-0 nylon. This area was dressed sterilely. The patient was repositioned more prone, and prepped and draped about the occipital parietal scalp was undertaken from the postauricular area to the postauricular area. Infiltration of Xylocaine with epinephrine was carried out about the tumor and to the postauricular sulci on either side. Then a patterned excision of a 6 cm fungating tumor was undertaken. Bleeding was controlled with cautery. The tumor was seen to be affixed to the parietal occipital skull, and was removed in the subperiosteal plane from this area. Bleeding was re-controlled. Relaxing incisions were made into the postauricular sulci on both the right and left sides. Then anterior flaps were raised as a vertical extension anteriorly, it was also lifted off the underlying galea. These flaps were vascularized from the superficial temporal vessels. These were preserved as the galea was scored to allow for advancement to the midline. Then, the posterior flap was lifted off the occiput and again the galea scored with the flap based on occipital vessels. It was advanced for closure. Bleeding was controlled with cautery.
OPERATION PERFORMED:
1. Excision of occipital parietal scalp with vascularized scalp flap reconstruction.
2. Incisional biopsy, right paramedian chest.
Work was begun at the anterior chest. A 4 cm horizontal incision was made over the dome of this fixed mass over the anterior chest. Dissection was carried through skin and subcutaneous tissue, and underlying portions of the pectoralis to expose an encapsulated tumor affixed to ribs, a 1 x 2 cm ellipse from the tumor was harvested for diagnosis. Bleeding was controlled with cautery. Closure was with interrupted 3-0 Vicryl, interrupted and running 4-0 nylon. This area was dressed sterilely. The patient was repositioned more prone, and prepped and draped about the occipital parietal scalp was undertaken from the postauricular area to the postauricular area. Infiltration of Xylocaine with epinephrine was carried out about the tumor and to the postauricular sulci on either side. Then a patterned excision of a 6 cm fungating tumor was undertaken. Bleeding was controlled with cautery. The tumor was seen to be affixed to the parietal occipital skull, and was removed in the subperiosteal plane from this area. Bleeding was re-controlled. Relaxing incisions were made into the postauricular sulci on both the right and left sides. Then anterior flaps were raised as a vertical extension anteriorly, it was also lifted off the underlying galea. These flaps were vascularized from the superficial temporal vessels. These were preserved as the galea was scored to allow for advancement to the midline. Then, the posterior flap was lifted off the occiput and again the galea scored with the flap based on occipital vessels. It was advanced for closure. Bleeding was controlled with cautery.