AN2114
Guru
The doctor did closure of tracheocutaneous fistula with rotational muscle flap, complex multi layer closure/plastic closure. I have cpt code 31825. Does that code include doing a rotational muscle flap or can I code 14040 with 31825? I didn't see any NCCI edits but I wasn't sure if the muscle flap is included in 31825 or if the muscle flap can be separately billed. Here is the op note:
Procedure: DLB, closure tracheocutaneous fistula with rotational muscle flap, complex multi layer closure/plastic closure
Details: Patient brought to OR. Timeout was called indicating correct patient and procedure. Anesthesia was induced with masked ventilation. Once all equipment was set up, the mask was removed. Using a miller laryngoscope the supraglottic structures we evaluated, no gross abnormalities were identified, no signs of laryngomalacia or GERD were observed. Using a rigid bronchoscope the glottic introitus was entered. The immediate subglottis was of normal caliber.
The proximal trachea was normal with a large tracheal stoma. The distal trachea demonstrated normal. No blunting of the carina was observed. The right and left mainstem bronchi were without abnormality. No foreign bodies were observed. Scope was removed. Patient was intubated.
The neck was then prepped and draped in the usual fashion. An elliptical incision 2cm in length was marked around the fistula and incision was made with a 15 blade. The tract was followed circumferentially deep to the strap muscles, which were vertically spread and partially separated. The tract was followed deep until the cartilage of the trachea was reached. At this point the fistula was suture ligated with 2-0 silk and tied off and then resected. A rotational strap muscle flap was created to cover the remaining stump. This was attached to the contralateral strap muscles. Another layer of strap muscles was closed over this with 4-0 Vicryl. The wound was thoroughly irrigated and suctioned dry. Hemostasis was achieved. The wound was closed in 3 layers with deep 4-0 vicryl, platysma 4-0 vicryl, and simple interrupted 5-0 fast. A rubber band drain was left in place. Steris and mastasol were placed and wound was dressed.
Procedure: DLB, closure tracheocutaneous fistula with rotational muscle flap, complex multi layer closure/plastic closure
Details: Patient brought to OR. Timeout was called indicating correct patient and procedure. Anesthesia was induced with masked ventilation. Once all equipment was set up, the mask was removed. Using a miller laryngoscope the supraglottic structures we evaluated, no gross abnormalities were identified, no signs of laryngomalacia or GERD were observed. Using a rigid bronchoscope the glottic introitus was entered. The immediate subglottis was of normal caliber.
The proximal trachea was normal with a large tracheal stoma. The distal trachea demonstrated normal. No blunting of the carina was observed. The right and left mainstem bronchi were without abnormality. No foreign bodies were observed. Scope was removed. Patient was intubated.
The neck was then prepped and draped in the usual fashion. An elliptical incision 2cm in length was marked around the fistula and incision was made with a 15 blade. The tract was followed circumferentially deep to the strap muscles, which were vertically spread and partially separated. The tract was followed deep until the cartilage of the trachea was reached. At this point the fistula was suture ligated with 2-0 silk and tied off and then resected. A rotational strap muscle flap was created to cover the remaining stump. This was attached to the contralateral strap muscles. Another layer of strap muscles was closed over this with 4-0 Vicryl. The wound was thoroughly irrigated and suctioned dry. Hemostasis was achieved. The wound was closed in 3 layers with deep 4-0 vicryl, platysma 4-0 vicryl, and simple interrupted 5-0 fast. A rubber band drain was left in place. Steris and mastasol were placed and wound was dressed.