How would this be billed. 32601 and 32550 or just 32550
PROCEDURES PERFORMED:
1. VATS drainage of left pleural effusion.
2. Left PleurX catheter placement.
3. Intercostal nerve block.
PROCEDURE IN DETAIL: The patient was taken to the Operating Room and placed on
the table in the supine position. After induction of general endotracheal tube
anesthesia, the patient was placed in the right lateral decubitus position and
the left chest was prepped and draped in a standard surgical fashion.
Appropriate timeout was then performed. A 2 cm incision was made in the
anterior axillary line at approximately the 7th rib space. This was carried
down to the intercostals with the Bovie electrocautery. Ventilation was then
held and the chest was bluntly entered with a tonsil forceps. Digital
inspection revealed appropriate position in the chest cavity. Entire suction
was then introduced and effusion was evacuated. Approximately 2100 mL of clear
amber fluid was removed. The trocar was introduced and the camera was inserted.
There were minimal adhesions present on one inspection. There was early
membranous entrapment of the left lower lobe. No other abnormalities were
identified. Given the patient's current immunosuppressed state with prednisone
and Prograf, decision was made not to perform a decortication. Counterincision
was made inferiorly and a PleurX catheter was tunneled superiorly to the
previous incision. Catheter was then inserted into the chest and visual
confirmation with the scope was used to confirm placement in the posterior
basilar area on the left chest. The scope was then withdrawn. Intercostal
muscles were closed with a running 2-0 Vicryl stitch. All skin incisions were
then closed with a running subcuticular 2-0 Vicryl stitch. Pleurx catheter was
secured with a 2-0 Prolene. An appropriate dressing was applied. The catheter
was placed to Pleur-evac suction
PROCEDURES PERFORMED:
1. VATS drainage of left pleural effusion.
2. Left PleurX catheter placement.
3. Intercostal nerve block.
PROCEDURE IN DETAIL: The patient was taken to the Operating Room and placed on
the table in the supine position. After induction of general endotracheal tube
anesthesia, the patient was placed in the right lateral decubitus position and
the left chest was prepped and draped in a standard surgical fashion.
Appropriate timeout was then performed. A 2 cm incision was made in the
anterior axillary line at approximately the 7th rib space. This was carried
down to the intercostals with the Bovie electrocautery. Ventilation was then
held and the chest was bluntly entered with a tonsil forceps. Digital
inspection revealed appropriate position in the chest cavity. Entire suction
was then introduced and effusion was evacuated. Approximately 2100 mL of clear
amber fluid was removed. The trocar was introduced and the camera was inserted.
There were minimal adhesions present on one inspection. There was early
membranous entrapment of the left lower lobe. No other abnormalities were
identified. Given the patient's current immunosuppressed state with prednisone
and Prograf, decision was made not to perform a decortication. Counterincision
was made inferiorly and a PleurX catheter was tunneled superiorly to the
previous incision. Catheter was then inserted into the chest and visual
confirmation with the scope was used to confirm placement in the posterior
basilar area on the left chest. The scope was then withdrawn. Intercostal
muscles were closed with a running 2-0 Vicryl stitch. All skin incisions were
then closed with a running subcuticular 2-0 Vicryl stitch. Pleurx catheter was
secured with a 2-0 Prolene. An appropriate dressing was applied. The catheter
was placed to Pleur-evac suction