CULINTZ
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Help! CPT code for thoracotomy for control of bleed? 32110 or 32120? Anything? 32560 or 32650 for talc pleurodesis? Thanks!
Procedure: Right VATS, pleural biopsies, converted to open thoracotomy for
control of bleed, talc pleurodesis, flexible bronchoscopy
Pre-op diagnosis: Right effusion, multiple pleural-based and lung nodules
Post-op diagnosis: same, frozen section probable malignancy
Findings: diffuse studding of the parietal and visceral pleurae, multiple small
pulmonary nodules
Operative report:
After satisfactory double-lumen endotracheal anesthesia, the patient was
bronchoscoped; no endobronchial pathology found. The patient was then placed in
the left lateral decubitus position and prepped and draped as per routine.
Through a port placed in the right mid-axillary line, 5th interspace, the pleura
was enterd and felt to be diffusely studded. The camera port was then placed in
the 8th interspace. 350 cc serous fluid was encountered and sent for cytology
and culture.There was diffuse studding of the visceral and parietal pleura and
several 1-3 cm nodules over the esophagus,although the esophagus did not appear
to be involved. Using the endoscissors, one of the pleural nodules was excised
and sent for frozen section. The pathologist could not make a diagnosis of
malignancy, but felt that it was very suspicious, so further samples were taken
and sent fresh for various tumor markers. During biopsy of one of the nodules, a
chest wall vein was torn, requiring 5th interspace thoracotomy for suture control.
Multiple other nodules were noted and biopsies taken, a sample of a
middle lobe nodule was also taken using the endogia stapler, all were sent
fresh. Talc was then insufflated over the visceral pleura, a #36 chest tube
placed through the camera port and 1 liter of warm saline instilled and the lung
re-expanded. The thoracotomy incision was closed with four #2 vicryl pericostal
sutures, 10 cc of 0.5% marcaine injected into the 4th, fifth and sixth
interspaces posterior to the incision, muscle closed with 0 vicryl, 2-0 and 4-0
vicryl for subq and skin. Sponge, needle and instrument counts were reported as
correct, and the patient was taken to PACU after dressings were applied and the
patient was extubated. The findings were reported and discussed with the family.
Procedure: Right VATS, pleural biopsies, converted to open thoracotomy for
control of bleed, talc pleurodesis, flexible bronchoscopy
Pre-op diagnosis: Right effusion, multiple pleural-based and lung nodules
Post-op diagnosis: same, frozen section probable malignancy
Findings: diffuse studding of the parietal and visceral pleurae, multiple small
pulmonary nodules
Operative report:
After satisfactory double-lumen endotracheal anesthesia, the patient was
bronchoscoped; no endobronchial pathology found. The patient was then placed in
the left lateral decubitus position and prepped and draped as per routine.
Through a port placed in the right mid-axillary line, 5th interspace, the pleura
was enterd and felt to be diffusely studded. The camera port was then placed in
the 8th interspace. 350 cc serous fluid was encountered and sent for cytology
and culture.There was diffuse studding of the visceral and parietal pleura and
several 1-3 cm nodules over the esophagus,although the esophagus did not appear
to be involved. Using the endoscissors, one of the pleural nodules was excised
and sent for frozen section. The pathologist could not make a diagnosis of
malignancy, but felt that it was very suspicious, so further samples were taken
and sent fresh for various tumor markers. During biopsy of one of the nodules, a
chest wall vein was torn, requiring 5th interspace thoracotomy for suture control.
Multiple other nodules were noted and biopsies taken, a sample of a
middle lobe nodule was also taken using the endogia stapler, all were sent
fresh. Talc was then insufflated over the visceral pleura, a #36 chest tube
placed through the camera port and 1 liter of warm saline instilled and the lung
re-expanded. The thoracotomy incision was closed with four #2 vicryl pericostal
sutures, 10 cc of 0.5% marcaine injected into the 4th, fifth and sixth
interspaces posterior to the incision, muscle closed with 0 vicryl, 2-0 and 4-0
vicryl for subq and skin. Sponge, needle and instrument counts were reported as
correct, and the patient was taken to PACU after dressings were applied and the
patient was extubated. The findings were reported and discussed with the family.