Tmatthews
Contributor
Little help please...
The doctor reported revision (obviously no longer a cpt code) but i believe its a debridement code. Input anyone?
74 year old male who presented to the clinic with left chest wound dehiscence at the site of his previous pacemaker pocket revision. He underwent recent PPM extraction following device infection. He is planned for atrial flutter ablation. He denies fevers, rigors.
PROCEDURE
The patient was brought to the Cardiac Electrophysiology laboratory in a post-absorptive, fasting state. Informed consent was obtained. A peripheral IV was in place. Continuous electrocardiographic, blood pressure, O2 saturation and expired CO2 monitoring was initiated. Intravenous antibiotics were administered pre-operatively. Self-adhesive cardioversion patches were positioned on the chest. Conscious sedation was effectuated according to protocol by the anesthesia service. The patient was then prepped and draped in the usual sterile fashion. A 50/50 mixture of lidocaine (1%) with epinephrine and bupivicaine (0.5%) was utilized for local anesthesia. Devitalized tissue was observed around the rim of the wound dehiscence with several sutures loosely apposing the wound edges. There was a devitalized base noted in the pocket. Extensive removal of the devitalized tissue was performed at the base of the pocket. The devitalized tissue around the rim of the wound dehiscence was also excised. Extensive bleeding was noted on the pocket and QuickClot material was applied. The pocket was then closed in four layers using 2-O vicryl, 3-O vicryl, and 4-O monocryl absorbable suture material. The skin was closed using a sub-cuticular technique. Ster-stips and a bio-occlusive dressing were applied to the skin. The patient remained hemodynamically stable, tolerated the procedure well and was transferred in stable condition. There were no immediate complications encountered during the procedure. There was minimal blood loss and no specimen were removed.
The doctor reported revision (obviously no longer a cpt code) but i believe its a debridement code. Input anyone?
74 year old male who presented to the clinic with left chest wound dehiscence at the site of his previous pacemaker pocket revision. He underwent recent PPM extraction following device infection. He is planned for atrial flutter ablation. He denies fevers, rigors.
PROCEDURE
The patient was brought to the Cardiac Electrophysiology laboratory in a post-absorptive, fasting state. Informed consent was obtained. A peripheral IV was in place. Continuous electrocardiographic, blood pressure, O2 saturation and expired CO2 monitoring was initiated. Intravenous antibiotics were administered pre-operatively. Self-adhesive cardioversion patches were positioned on the chest. Conscious sedation was effectuated according to protocol by the anesthesia service. The patient was then prepped and draped in the usual sterile fashion. A 50/50 mixture of lidocaine (1%) with epinephrine and bupivicaine (0.5%) was utilized for local anesthesia. Devitalized tissue was observed around the rim of the wound dehiscence with several sutures loosely apposing the wound edges. There was a devitalized base noted in the pocket. Extensive removal of the devitalized tissue was performed at the base of the pocket. The devitalized tissue around the rim of the wound dehiscence was also excised. Extensive bleeding was noted on the pocket and QuickClot material was applied. The pocket was then closed in four layers using 2-O vicryl, 3-O vicryl, and 4-O monocryl absorbable suture material. The skin was closed using a sub-cuticular technique. Ster-stips and a bio-occlusive dressing were applied to the skin. The patient remained hemodynamically stable, tolerated the procedure well and was transferred in stable condition. There were no immediate complications encountered during the procedure. There was minimal blood loss and no specimen were removed.