I would like some input on codes for the following op note. I'm definitely using 32652 but questioning if i should bill 32653 for the evacuation of empyemas.PREOPERATIVE DIAGNOSIS: Left empyema.
POSTOPERATIVE DIAGNOSIS: Left empyema.
PROCEDURE:
1. Flexible bronchoscopy.
2. Left thoracoscopic evacuation of empyema.
3. Total left lung decortication.
FINDINGS: She had dense intrapleural adhesions throughout her entire pleural space. During the course of mobilization of the left lung, five separate pockets of white thick purulent fluid were encountered and drained. The lung was decorticated entirely. The chest was irrigated with six liters of warm saline and specimen sent for culture.
DESCRIPTION OF PROCEDURE: The patient was identified in the holding area and taken to the operating room where she was placed supine on the operating room table. After induction of anesthesia, she was intubated with a double lumen endotracheal tube. I then did flexible bronchoscopy which revealed thick mucous secretions endobronchially. These were suctioned to the extent possible. She was then turned left side up and her left chest prepped and draped in the usual fashion. An anterior-inferior camera port incision was made in the seventh interspace. The pleural space was entered, and the lung was completely and densely adherent to the parietal pleura. Using a combination of sharp dissection and Bovie cautery, the lung was mobilized enough to insert the thoracoscope. Once we had some room for visualization, the lung was further mobilized sufficiently for placement of anterior and posterior port sites. Through these three working ports, the lung was mobilized completely. There were five separate areas of what was frank pus which were extremely well walled off. The abscess cavities were very mature with thick rinds. In most cases, the lung was mobilized off of the abscess cavity prior to opening it, which decorticated the lung. The largest cavity was at the inferior aspect of the left lower lobe at the base, and adherent to this was an area of the left lower lobe which was necrotic. Dissection of this area required enlargement of one of the thoracoscopic sites, but no ribs were spread. The diaphragm was mobilized off the base of the lung, the left lower lobe elevated, and the final and largest abscess cavity was drained and the rind from this removed to the extent possible. We then placed a 28-French right angle chest tube and a 24 HydroGlide tube around the apex. The lung was visualized to reinflate well to the chest wall and we then irrigated with six liters of warm saline which was clear at the completion of the irrigation. The lung was reinflated.