jthahn@tds.net
Contributor
Need help with coding,
Bronchoscopy shows normal bronchial tree with no masses, moderate to excessive amount of secretions
the entire right lung was trapped, there were very dense , thick parietal and visceral pleura (fibrotic).
Procedure in detail:
After proper identification, the patient was brought to the operating theater and placed supine on a well-padded operating table where general endotracheal anesthesia was administered. A Bronchoscopy was performed, findings above, a double lumen ET tube was then placed, an A line was placed. The patient was then placed in left decubitus position. A surgical pause was conducted, and the patient was prepped and draped in the usual sterile fashion. Prior to the beginning of the procedure, the team paused to verify the patient's identity, as well as the procedure to be performed and the correct side/site. All equipment required was ready and available. The patient was positioned appropriately. The following team members were present during the team pause: OR RNs, anesthesia team, and surgeons.
A single lung ventilation was ensued. A 12 mm incision was made in the posterior axillary line in the 6th intercostal space. A port was inserted, a 30 degree angled thoracoscope was placed and the right thoracic cavity was inspected. This revealed very thick parietal and visceral pleura covering a trapped right lung with failure to expand with ventilation. At this point I decided to proceed with right anterolateral thoracotomy and decortication. An incision was made along the 4th intercostal space. The parietal pleural was peeled off using blunt dissection. Next the visceral pleura was dissected using combination of sharp and blunt dissection. Until the entire lung was mobilized, the decortication was done on and off single lung ventilation to aid with dissection and plane recognition. There were multiple laceration to the lung surface. Tissel and Coseal were utilized to minimize air leak over these lacerations. The lung expansion was satisfactory at the end of the procedure. There was about 200mls air leak.
All tissue was sent to pathology. 2x 28 Fr chest tube was then placed and secured with 2 -0 nylon. The lung was reinflated under vision.
32320
31622
or
31622
32220
32601
Any help is appreciated.
Bronchoscopy shows normal bronchial tree with no masses, moderate to excessive amount of secretions
the entire right lung was trapped, there were very dense , thick parietal and visceral pleura (fibrotic).
Procedure in detail:
After proper identification, the patient was brought to the operating theater and placed supine on a well-padded operating table where general endotracheal anesthesia was administered. A Bronchoscopy was performed, findings above, a double lumen ET tube was then placed, an A line was placed. The patient was then placed in left decubitus position. A surgical pause was conducted, and the patient was prepped and draped in the usual sterile fashion. Prior to the beginning of the procedure, the team paused to verify the patient's identity, as well as the procedure to be performed and the correct side/site. All equipment required was ready and available. The patient was positioned appropriately. The following team members were present during the team pause: OR RNs, anesthesia team, and surgeons.
A single lung ventilation was ensued. A 12 mm incision was made in the posterior axillary line in the 6th intercostal space. A port was inserted, a 30 degree angled thoracoscope was placed and the right thoracic cavity was inspected. This revealed very thick parietal and visceral pleura covering a trapped right lung with failure to expand with ventilation. At this point I decided to proceed with right anterolateral thoracotomy and decortication. An incision was made along the 4th intercostal space. The parietal pleural was peeled off using blunt dissection. Next the visceral pleura was dissected using combination of sharp and blunt dissection. Until the entire lung was mobilized, the decortication was done on and off single lung ventilation to aid with dissection and plane recognition. There were multiple laceration to the lung surface. Tissel and Coseal were utilized to minimize air leak over these lacerations. The lung expansion was satisfactory at the end of the procedure. There was about 200mls air leak.
All tissue was sent to pathology. 2x 28 Fr chest tube was then placed and secured with 2 -0 nylon. The lung was reinflated under vision.
32320
31622
or
31622
32220
32601
Any help is appreciated.