should both 21750 and 35820 be billed or just the 21750
The patient was brought to the Operating Room and placed
in a supine position. After induction of anesthesia, area was prepped and
draped in the usual sterile fashion. The temporary sternal dressing was taken
down. A chest retractor was placed. On visualization, we noticed a
golf-ball-sized hematoma that was around the aortic anastomotic site,
compressing the RV and the left atrium. It was also at the site where a right
atrial dissection had been carried out. That was removed, and immediately,
significant decrease in the CVP was noted. After that, washout of the
mediastinum was carried out with warm saline containing antibiotic solutions.
Once good hemostasis, we placed a pledgeted 5-0 Prolene stitch at the
anastomotic site and it resulted in good hemostasis. After that, we were
satisfied with the hemostasis, a washout of the mediastinum carried out. The
chest tubes were then washed and repositioned. Once satisfied, we wanted to
proceed with the closure of the chest. Creation of new pericardium was done.
This was done for reentry purposes at the time of transplant. A 1 mm Gore-Tex
membrane was used, which was attached to the edges of the pericardium all around
with multiple silk pop-off stitches. Once we were done with that, the sternum
was then approximated with #6 stainless steel wires. Good hemostasis was
ensured. Skin and subcutaneous tissues were closed in multiple layers. A
sterile dressing was applied. Terminal count of needles, sponges, and
instrument was found to be correct.
The patient was brought to the Operating Room and placed
in a supine position. After induction of anesthesia, area was prepped and
draped in the usual sterile fashion. The temporary sternal dressing was taken
down. A chest retractor was placed. On visualization, we noticed a
golf-ball-sized hematoma that was around the aortic anastomotic site,
compressing the RV and the left atrium. It was also at the site where a right
atrial dissection had been carried out. That was removed, and immediately,
significant decrease in the CVP was noted. After that, washout of the
mediastinum was carried out with warm saline containing antibiotic solutions.
Once good hemostasis, we placed a pledgeted 5-0 Prolene stitch at the
anastomotic site and it resulted in good hemostasis. After that, we were
satisfied with the hemostasis, a washout of the mediastinum carried out. The
chest tubes were then washed and repositioned. Once satisfied, we wanted to
proceed with the closure of the chest. Creation of new pericardium was done.
This was done for reentry purposes at the time of transplant. A 1 mm Gore-Tex
membrane was used, which was attached to the edges of the pericardium all around
with multiple silk pop-off stitches. Once we were done with that, the sternum
was then approximated with #6 stainless steel wires. Good hemostasis was
ensured. Skin and subcutaneous tissues were closed in multiple layers. A
sterile dressing was applied. Terminal count of needles, sponges, and
instrument was found to be correct.