CRC CPC
Guru
Please help,
I can't find a code for thoracic lymph node sampling:
Right thoracotomy.
2. Lymph node sampling of the hilar lymph nodes.
COMPLICATIONS:
None.
BLOOD LOSS:
50 mL.
FINDINGS:
Enlarged lymph nodes throughout the right hilum.
INDICATIONS:
is a 69-year-old gentleman who has mediastinal adenopathy. He
does have some lymph nodes of smaller caliber, which could be reached with a
mediastinoscope. However, the larger lymph nodes are deeper within the
mediastinum, which the mediastinoscope could not reach. I explained to him
that we could get a negative result on a piece, which could be inclusive, or I
could get the enlarged lymph nodes all together and take a more definitive
sampling of the right side. He wished to proceed with a right thoracotomy
after giving him the risks and benefits of the mediastinoscopy versus right
thoracotomy. Risks include death, stroke, myocardial infarction, particularly
with history of stents and off his Effient. Bleeding, infection, damage to
the phrenic nerve, or the laryngeal nerve, which could cause either phrenic
nerve, diaphragm paralysis, or laryngeal nerve vocal cord dysfunction.
OPERATIVE COURSE:
After informed consent, the patient was placed in supine position. Double
lumen tube was then placed. Left lateral decubitus position was then
established, exposing the right chest. A thoracotomy was performed. This was
an extremely large gentleman with thick muscle. The access to the mediastinal
lobe nodes were easily evaluated. The nodes were actually right on the
phrenic nerve. The nodes themselves were pushed away from the phrenic and
electrocautery was not utilized by the phrenic. Small clips were applied
followed by sharp dissection, removing the series of nodes with good and lymph
node sampling. Cultures were sent as well as pathology for analysis. The
ribs were block followed by standard closure, followed by 2 layer fascial,
subcuticular stitch. One 24-French chest tube placed.
______________________________
I can't find a code for thoracic lymph node sampling:
Right thoracotomy.
2. Lymph node sampling of the hilar lymph nodes.
COMPLICATIONS:
None.
BLOOD LOSS:
50 mL.
FINDINGS:
Enlarged lymph nodes throughout the right hilum.
INDICATIONS:
is a 69-year-old gentleman who has mediastinal adenopathy. He
does have some lymph nodes of smaller caliber, which could be reached with a
mediastinoscope. However, the larger lymph nodes are deeper within the
mediastinum, which the mediastinoscope could not reach. I explained to him
that we could get a negative result on a piece, which could be inclusive, or I
could get the enlarged lymph nodes all together and take a more definitive
sampling of the right side. He wished to proceed with a right thoracotomy
after giving him the risks and benefits of the mediastinoscopy versus right
thoracotomy. Risks include death, stroke, myocardial infarction, particularly
with history of stents and off his Effient. Bleeding, infection, damage to
the phrenic nerve, or the laryngeal nerve, which could cause either phrenic
nerve, diaphragm paralysis, or laryngeal nerve vocal cord dysfunction.
OPERATIVE COURSE:
After informed consent, the patient was placed in supine position. Double
lumen tube was then placed. Left lateral decubitus position was then
established, exposing the right chest. A thoracotomy was performed. This was
an extremely large gentleman with thick muscle. The access to the mediastinal
lobe nodes were easily evaluated. The nodes were actually right on the
phrenic nerve. The nodes themselves were pushed away from the phrenic and
electrocautery was not utilized by the phrenic. Small clips were applied
followed by sharp dissection, removing the series of nodes with good and lymph
node sampling. Cultures were sent as well as pathology for analysis. The
ribs were block followed by standard closure, followed by 2 layer fascial,
subcuticular stitch. One 24-French chest tube placed.
______________________________