Would someone be able to suggest the correct CPT codes for these procedures? Thanks for any help you can give.
1.Open debridement of right persistent pleural cavity through a posterolateral right chest wall incision with partial resection of a rib.
2.Intraoperative cultures obtained.
3.Placement of 24 Blake drain and 28 right angle chest tube.
4.Intraoperative flexible bronchoscopy.
Procedure:
Recent CT scan of his right chest which was marked by radiology so I could make the appropriate skin incision over the area of the chronic persistent pleural cavity. Each incision was made along the skin lines and the ribs in the marked area. This was extended through the subcutaneous tissue. Several rib spaces were localized and retractors were placed. Initially made an incision above one of the ribs at the marked area, however, just below this was thickened pleura and then lung. I made a small incision into the lung and felt that this was obviously not the interspace to use. I then went down one interspace and in fact at this point I resected approximately 2 inches of the rib overlying the space and then carefully dissected down through markedly thickened pleura at least 1 cm in thickness. I eventually obtained a plane that led me to this of what appeared to be the chronic pleural space that was identified on the CT scan. There were no other spaces identified. I did dissect distally down towards the diaphragm. There was no fluid identified here. There was thickened material that did not appear to be infected and scar tissue. He had significant amount of scarring around the area and these adhesions were carefully taken down with electrocautery to minimize blood loss. Eventually I followed this space posterior, inferior and then superior as directed by the CT scan which was available to me in the operating room. As noted this was only open cavity space that I could find and I felt that this was the appropriate area. There was no pus identified. No obvious active infection. He did have some fluid in that cavity which I removed and this was sent for cultures. We then irrigated this cavity and debrided this area and completely evacuated this persistent pleural space. Any bleeding was controlled with electrocautery. There was no obvious bronchopleural fistula with filling this cavity and then allowing anesthesia to increase the tidal volume. No bubbles were identified. At completion I evacuated the irrigant and then tunneled a 28 right angle chest tube from anterior through the open rib space down into this persistent pleural cavity along with a 24 Blake drain. Both were sutured to the skin. I flet we had adequately drained this area and no further resection was needed. The muscle around the resected rib was now reapproximated with a running Vicryl stitch. The second layer soft tissue was closed in a similar fashion as was a third layer and then the skin was closed with a subcuticular stitch.
1.Open debridement of right persistent pleural cavity through a posterolateral right chest wall incision with partial resection of a rib.
2.Intraoperative cultures obtained.
3.Placement of 24 Blake drain and 28 right angle chest tube.
4.Intraoperative flexible bronchoscopy.
Procedure:
Recent CT scan of his right chest which was marked by radiology so I could make the appropriate skin incision over the area of the chronic persistent pleural cavity. Each incision was made along the skin lines and the ribs in the marked area. This was extended through the subcutaneous tissue. Several rib spaces were localized and retractors were placed. Initially made an incision above one of the ribs at the marked area, however, just below this was thickened pleura and then lung. I made a small incision into the lung and felt that this was obviously not the interspace to use. I then went down one interspace and in fact at this point I resected approximately 2 inches of the rib overlying the space and then carefully dissected down through markedly thickened pleura at least 1 cm in thickness. I eventually obtained a plane that led me to this of what appeared to be the chronic pleural space that was identified on the CT scan. There were no other spaces identified. I did dissect distally down towards the diaphragm. There was no fluid identified here. There was thickened material that did not appear to be infected and scar tissue. He had significant amount of scarring around the area and these adhesions were carefully taken down with electrocautery to minimize blood loss. Eventually I followed this space posterior, inferior and then superior as directed by the CT scan which was available to me in the operating room. As noted this was only open cavity space that I could find and I felt that this was the appropriate area. There was no pus identified. No obvious active infection. He did have some fluid in that cavity which I removed and this was sent for cultures. We then irrigated this cavity and debrided this area and completely evacuated this persistent pleural space. Any bleeding was controlled with electrocautery. There was no obvious bronchopleural fistula with filling this cavity and then allowing anesthesia to increase the tidal volume. No bubbles were identified. At completion I evacuated the irrigant and then tunneled a 28 right angle chest tube from anterior through the open rib space down into this persistent pleural cavity along with a 24 Blake drain. Both were sutured to the skin. I flet we had adequately drained this area and no further resection was needed. The muscle around the resected rib was now reapproximated with a running Vicryl stitch. The second layer soft tissue was closed in a similar fashion as was a third layer and then the skin was closed with a subcuticular stitch.