jewlz0879
True Blue
Hi there
Three years away from CT surgery and I am rusty! It's coming back but I feel 'off' on this report. I'm not sure about the 19271 and I feel 32507 is wrong because doc states chest wall tumor and resection. I would really appreciate some help and feedback on this.
19271
32220
32480
32507? or 32505
39401
Right LL cancer - C34.31
Patient has Medicare so I did not bill for thoracoscopy since doc converted to thoracotomy and if I remember correctly, MC won't pay for that; they will pay for the open procedure only.
Mediastinoscopy with multiple mediastinal biopsies.
2. Right thoracoscopy with lysis of adhesion.
3. Right thoracotomy with complete decortication of right lung.
4. Right lower lobectomy.
5. Wedge resection, right middle lobe.
6. Resection of chest wall tumor with neurovascular identification and preservation and reconstruction of chest wall.
BRIEF OPERATIVE REPORT:
Following delivery into the operating room and placement in a supine position on the operating table and successful induction
of general anesthesia with placement of an endotracheal tube by the anesthesiologist, the appropriate monitoring devices were
established and the patient was positioned in the mediastinoscopy osition and his neck and anterior chest were prepped and draped in the usual sterile manner. The skin incision was made 2 fingerbreadths above the sternal notch using a #10 scalpel to cut down through the skin, and subcutaneous tissues were divided using electrocautery in a coagulating mode until the anterior mediastinum was entered. The anterior mediastinum was entered using blunt finger dissection and the mediastinoscope was inserted. The mediastinal nodes were removed and sampled and sent to Pathology from level 7, level 4R, level 4 L, and level 2L lymph node stations. All frozen sections from the biopsies of the mediastinal nodes were negative. Hemostasis was demonstrated and the wound was closed with 2 layers of 2-0 Vicryl followed by a running 4-0 Monocryl skin closure followed by Steri-Strips and clean sterile dressings. The patient was then repositioned in the lateral thoracotomy position with the right chest up. The patient's chest was reprepped and draped in the usual sterile manner and a skin incision was made in the 8th interspace using a #10 scalpel to cut down through the skin, and subcutaneous tissues were divided using electrocautery in a coagulating mode until the pleural cavity was reached and entered. The thoracoscope was inserted. There were some adhesions of the lung to the chest wall, which were able to be lysed thoracoscopically; however, the tumor itself was large and adherent to the chest wall and it was felt that a thoracotomy incision was warranted. Thus, a thoracotomy incision was made using a #10 scalpel to cut down through the skin, and subcutaneous tissues were divided using electrocautery in a coagulating mode until the pleural cavity was reached and entered. A chest retractor was placed. The tumor was able to be removed away from the chest wall chest wall, and the chest wall where it was attached to was resected under direct vision after the neurovascular bundle was identified and preserved. The specimen of the chest wall was sent to Pathology. The resected site of the chest wall was repaired using silk sutures.
Then, attention was directed towards doing a right lower lobectomy and control of the vasculature on the bronchial stumps
was obtained using multiple firings the Power-Echelon stapling device. The lower lobectomy was performed. The tumor itself was also adherent very closely to the middle lobe. It did not appear to be grossly involving the middle lobe; however, it was very close to it. The staple line was at that junction and thus it was decided to do a wedge resection of the middle lobe at this area as well. This was performed without difficulty and hemostasis was demonstrated. The lung was inspected where the
decortication had been performed. The decortication was performed when we first entered. Complete decortication of the
entire right lung had been performed because there was a reactive peel encasing and involving the lung. This was very filmy in nature and a small piece of it was able to be obtained and sent to Pathology. The remainder was able to be disrupted without difficulty, but great care was taken to avoid injury to the underlying lung parenchyma. Hemostasis was again demonstrated upon completion of the case and air leak was checked for and none was visible. A #36 straight chest tube was inserted under direct vision and secured using a pursestring and stay suture. The ribs were approximated with multiple #1 Ethibonds in a figure-of-eight fashion. The fascial and muscle layers were approximated with multiple layers of 0 Vicryl followed by 2-0 Vicryl followed by a running 4-0 Monocryl skin closure followed by Steri-Strips and clean sterile dressings. Needle, sponge, and instrument counts were correct for all aspects of the operation. The patient tolerated the procedure and was to be delivered to the Postanesthesia Care Unit on the way to the Intensive Care Unit in stable condition. The estimated blood loss was less than 10 mL, and there was no blood or blood products required for transfusion Intraoperatively.
Three years away from CT surgery and I am rusty! It's coming back but I feel 'off' on this report. I'm not sure about the 19271 and I feel 32507 is wrong because doc states chest wall tumor and resection. I would really appreciate some help and feedback on this.
19271
32220
32480
32507? or 32505
39401
Right LL cancer - C34.31
Patient has Medicare so I did not bill for thoracoscopy since doc converted to thoracotomy and if I remember correctly, MC won't pay for that; they will pay for the open procedure only.
Mediastinoscopy with multiple mediastinal biopsies.
2. Right thoracoscopy with lysis of adhesion.
3. Right thoracotomy with complete decortication of right lung.
4. Right lower lobectomy.
5. Wedge resection, right middle lobe.
6. Resection of chest wall tumor with neurovascular identification and preservation and reconstruction of chest wall.
BRIEF OPERATIVE REPORT:
Following delivery into the operating room and placement in a supine position on the operating table and successful induction
of general anesthesia with placement of an endotracheal tube by the anesthesiologist, the appropriate monitoring devices were
established and the patient was positioned in the mediastinoscopy osition and his neck and anterior chest were prepped and draped in the usual sterile manner. The skin incision was made 2 fingerbreadths above the sternal notch using a #10 scalpel to cut down through the skin, and subcutaneous tissues were divided using electrocautery in a coagulating mode until the anterior mediastinum was entered. The anterior mediastinum was entered using blunt finger dissection and the mediastinoscope was inserted. The mediastinal nodes were removed and sampled and sent to Pathology from level 7, level 4R, level 4 L, and level 2L lymph node stations. All frozen sections from the biopsies of the mediastinal nodes were negative. Hemostasis was demonstrated and the wound was closed with 2 layers of 2-0 Vicryl followed by a running 4-0 Monocryl skin closure followed by Steri-Strips and clean sterile dressings. The patient was then repositioned in the lateral thoracotomy position with the right chest up. The patient's chest was reprepped and draped in the usual sterile manner and a skin incision was made in the 8th interspace using a #10 scalpel to cut down through the skin, and subcutaneous tissues were divided using electrocautery in a coagulating mode until the pleural cavity was reached and entered. The thoracoscope was inserted. There were some adhesions of the lung to the chest wall, which were able to be lysed thoracoscopically; however, the tumor itself was large and adherent to the chest wall and it was felt that a thoracotomy incision was warranted. Thus, a thoracotomy incision was made using a #10 scalpel to cut down through the skin, and subcutaneous tissues were divided using electrocautery in a coagulating mode until the pleural cavity was reached and entered. A chest retractor was placed. The tumor was able to be removed away from the chest wall chest wall, and the chest wall where it was attached to was resected under direct vision after the neurovascular bundle was identified and preserved. The specimen of the chest wall was sent to Pathology. The resected site of the chest wall was repaired using silk sutures.
Then, attention was directed towards doing a right lower lobectomy and control of the vasculature on the bronchial stumps
was obtained using multiple firings the Power-Echelon stapling device. The lower lobectomy was performed. The tumor itself was also adherent very closely to the middle lobe. It did not appear to be grossly involving the middle lobe; however, it was very close to it. The staple line was at that junction and thus it was decided to do a wedge resection of the middle lobe at this area as well. This was performed without difficulty and hemostasis was demonstrated. The lung was inspected where the
decortication had been performed. The decortication was performed when we first entered. Complete decortication of the
entire right lung had been performed because there was a reactive peel encasing and involving the lung. This was very filmy in nature and a small piece of it was able to be obtained and sent to Pathology. The remainder was able to be disrupted without difficulty, but great care was taken to avoid injury to the underlying lung parenchyma. Hemostasis was again demonstrated upon completion of the case and air leak was checked for and none was visible. A #36 straight chest tube was inserted under direct vision and secured using a pursestring and stay suture. The ribs were approximated with multiple #1 Ethibonds in a figure-of-eight fashion. The fascial and muscle layers were approximated with multiple layers of 0 Vicryl followed by 2-0 Vicryl followed by a running 4-0 Monocryl skin closure followed by Steri-Strips and clean sterile dressings. Needle, sponge, and instrument counts were correct for all aspects of the operation. The patient tolerated the procedure and was to be delivered to the Postanesthesia Care Unit on the way to the Intensive Care Unit in stable condition. The estimated blood loss was less than 10 mL, and there was no blood or blood products required for transfusion Intraoperatively.