plasticscoder
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Hello All,
How would you code the following scenario?
PROCEDURE: Bilateral tissue expander reconstruction
with 8 x 16 cm piece of AlloDerm, bilateral fasciocutaneous flaps and use of
SPY angiography.
INDICATIONS: The patient presents after having undergone a bilateral mastectomy and we elected to proceed with the above reconstruction.
PROCEDURE IN DETAIL: The subpectoral pocket was created on each side with a cautery unit. The muscle was released off the fold. We took a low profile, full height 15 tissue expander and placed 1 beneath the pectoralis muscle on both sides. We then hydrated 2 pieces of AlloDerm, 8 x 16 cm each. These were sutured to the inframammary fold with multiple Vicryl sutures and then to the pectoralis muscle and draped over the expander. This provided full coverage of the expander. We then inflated the expander with 300 cc of normal saline. Intraoperative SPY angiography was performed to assess viability of the skin flaps by injecting 5 cc of indocyanine green. The upper mastectomy flaps appeared to be well perfused. We then elected to de-epithelialize the lower mastectomy flaps and used these as vascularized
fasciocutaneous flaps to completely cover the AlloDerm. It was tacked up to
the pectoralis muscle providing coverage of the AlloDerm. The pocket was
irrigated. Hemostasis was obtained. Drains were placed and the upper
mastectomy flap was then tacked down to the inframammary fold and the rest was shaped in layers with Monocryl. This completed the reconstruction. Dressings were applied and she was transferred stable to the PACU.
How would you code the following scenario?
PROCEDURE: Bilateral tissue expander reconstruction
with 8 x 16 cm piece of AlloDerm, bilateral fasciocutaneous flaps and use of
SPY angiography.
INDICATIONS: The patient presents after having undergone a bilateral mastectomy and we elected to proceed with the above reconstruction.
PROCEDURE IN DETAIL: The subpectoral pocket was created on each side with a cautery unit. The muscle was released off the fold. We took a low profile, full height 15 tissue expander and placed 1 beneath the pectoralis muscle on both sides. We then hydrated 2 pieces of AlloDerm, 8 x 16 cm each. These were sutured to the inframammary fold with multiple Vicryl sutures and then to the pectoralis muscle and draped over the expander. This provided full coverage of the expander. We then inflated the expander with 300 cc of normal saline. Intraoperative SPY angiography was performed to assess viability of the skin flaps by injecting 5 cc of indocyanine green. The upper mastectomy flaps appeared to be well perfused. We then elected to de-epithelialize the lower mastectomy flaps and used these as vascularized
fasciocutaneous flaps to completely cover the AlloDerm. It was tacked up to
the pectoralis muscle providing coverage of the AlloDerm. The pocket was
irrigated. Hemostasis was obtained. Drains were placed and the upper
mastectomy flap was then tacked down to the inframammary fold and the rest was shaped in layers with Monocryl. This completed the reconstruction. Dressings were applied and she was transferred stable to the PACU.