shubble
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Please help with this case. I was leaning toward CPT 32651 but not really sure. Here is the op note:
After appropriate informed consent was signed, the patient was taken to the operating room and transferred to the operating table, underwent double-lumen endotracheal tube. Foley catheter was placed in the right lateral decubitus position. I examined the patient in the preoperative holding area, marked the patient, all agreed was the left side. An incision in the left chest approximately the 5th or 6th intercostal space ausculatory triangle was made. Dissection carried down through skin and subcutaneous tissue. The muscles were gently split away and I got onto the rib. I went slightly above the rib without problems and I got into the chest where the chest wall stuck. I placed my finger and a trocar was then placed and 10-scope was then placed. The upper and lingular lobes were gently stuck to the left. There was a free space on the right. Through this same incision, a Kitner was used to take down the rest of the lung from the chest wall without incidence. After doing this, there was rind on the diaphragm. There was rind, thickened curd and cheese, gelatinous rind, all consistent with an empyema and the inferior part of the chest and on the parietal space. A 25-needle was used with a syringe, it was placed in the midaxillary line to go and over the diaphragm. I can see this and then a 10 trocar was placed and the camera was placed in this area to get better panoramic view. There was a hardened area in the left lingual and superior part of the left upper lobe consistent with an abscess from pneumonia. There was no gross mass appreciated. In order to aid with triangulation, another port was then placed in the medial part of this thorax on the left side of the initial injury, approximately 7 to 8 cm were medial under direct vision without problems. All the rind was then debris without any incidence and sent off and got the rind off the lower chest wall, the diaphragm and lung. There was nothing really medial. There was some oozing from this, but nothing really a great. After this, the lung can fully expand without problems. There were no other issues. The area was irrigated with approximately 2 liters of saline. A 28-French chest tube was placed under direct vision through the most lower trocar site and the camera was passed to knows there had been good position. The lung was reinflated and there was no gross air leak. Chest tube was sewn in with 2-0 nylon.
After appropriate informed consent was signed, the patient was taken to the operating room and transferred to the operating table, underwent double-lumen endotracheal tube. Foley catheter was placed in the right lateral decubitus position. I examined the patient in the preoperative holding area, marked the patient, all agreed was the left side. An incision in the left chest approximately the 5th or 6th intercostal space ausculatory triangle was made. Dissection carried down through skin and subcutaneous tissue. The muscles were gently split away and I got onto the rib. I went slightly above the rib without problems and I got into the chest where the chest wall stuck. I placed my finger and a trocar was then placed and 10-scope was then placed. The upper and lingular lobes were gently stuck to the left. There was a free space on the right. Through this same incision, a Kitner was used to take down the rest of the lung from the chest wall without incidence. After doing this, there was rind on the diaphragm. There was rind, thickened curd and cheese, gelatinous rind, all consistent with an empyema and the inferior part of the chest and on the parietal space. A 25-needle was used with a syringe, it was placed in the midaxillary line to go and over the diaphragm. I can see this and then a 10 trocar was placed and the camera was placed in this area to get better panoramic view. There was a hardened area in the left lingual and superior part of the left upper lobe consistent with an abscess from pneumonia. There was no gross mass appreciated. In order to aid with triangulation, another port was then placed in the medial part of this thorax on the left side of the initial injury, approximately 7 to 8 cm were medial under direct vision without problems. All the rind was then debris without any incidence and sent off and got the rind off the lower chest wall, the diaphragm and lung. There was nothing really medial. There was some oozing from this, but nothing really a great. After this, the lung can fully expand without problems. There were no other issues. The area was irrigated with approximately 2 liters of saline. A 28-French chest tube was placed under direct vision through the most lower trocar site and the camera was passed to knows there had been good position. The lung was reinflated and there was no gross air leak. Chest tube was sewn in with 2-0 nylon.