afryberger
Networker
Hello,
Would anybody be able to check my surgery CPT for this. This is my first time doing eye surgery.
66982, 67255, 66740
The site of surgery was properly noted and marked at the right side. The patient was placed with preop dilation drops into the right eye,.
Femtolaser was used to initially do the capsulotomy and breaking of the lens into pieces. While patient is sitting up on the stretcher, they first marked at 180 degrees in the left eye after placing proparacaine drops using the robomarker. The patient is then placed in supine position and the laser patient interface device , PID, placed on the left eye and when suction is attained, it is filled with water. The laser is docked onto the PID and locked. The laser now controls all the other processes until it allows me to step on the pedal and perform the laser for about 15 seconds. It automatically disengages the eye once finished and terminates the process. The patient is now ready to be prepped and draped for surgery. The rhexis could only be 4.4mm since the pupil would not dilate further from previous trauma at an explosion in a chemical factory and injured this eye .
In the operating room, the patient was prepped and draped in the usual sterile ophthalmic manner. IV sedation was given. More verbal anesthesia was also given. The lid speculum was placed in the right eye to be operated on. Lidocaine jelly 4% was placed initially on the surface of the cornea and the conjunctiva to keep the corneal surfacer moist and smooth to alleviate any discomfort. Pressure was to be expected, and the patient was verbally told this during the procedure and irrigation of BSS was to be expected throughout, and the patient understood. The sideport incision was made with the supersharp straight blade. Injection of lidocaine preservative free was done intracamerally. Air was placed prior to injecting the tryphan blue. This was immediately irrigated with BSS. The rhexis was removed with a Utratta forceps a perfectly curvilinear round rhexis 4.4mm round. The anterior chamber was filled with more viscoelastic .
Irrigation of the nucleus to separate the cortical material was performed with a bent cannula with BSS irrigating until the nucleus could be rotated. Omidira and BSS kept the pupil dilated and increased the comfort of the patient. Phacoemulsification of the lens as performed by first debulking and then proceeding with the divide and conquer method. Chopping was also necessary once the femto laser had initially chopped the lens and separation of the pieces was done manually with the phaco tip and Sinsky hook. Prior chopping of the laser made it much more amenable to phacoemusification despite the density of the lens. The CDE was 13.2. The cortical material was removed from the capsular bag using the cortical aspiration setting. The anterior and posterior capsule was polished with the silicone tip.
Prior to leaving the anterior chamber, viscoelastic was placed via the side port to prevent the posterior capsule from forward motion.
The bag was filled with the Provisc and the intraocular lens was inserted into the bag.
Epinsphrine 1:100,000 0.5cc diluted in 500ml of BSS and only 3cc of theis was placed under the iris at the nasal side for the placement of the Allo Flo. The bag was filled with the Provisc and thye DOBOO 22.5D IOL inserted into the bag. The head was tilted to the left and the goniolens was used to visualize the angle with the microscope which showed a n open angle anatomy. The TM and the scleral spur was seen with the gonio lens. Usint the tipo of the provisc , a cyclodialyis cleft was created by dissecting the irirs root from the sceral wall. One to 2 oclock hours of ciliary hours of ciliary body disinsertion were created horizontally at a depth of 4-5mm . Viscocycloplasty was subsequently performed to enlarge the cleft and tamponade any bleeding. Prior to the deployment of the reinforcing bioscaffold the allograft implant is inspected under the microscope for full containment within the cannulated carrier. The carrier was inserted into the cleft until the end of the graft could be seen with a 2mm outside the cleft showing. The holder was then retracted until the purple tubing could be seen. The instrument was removed from the chamber revealing a small stub in the cleft. Some active beleding could be seen and was stopped with Provisc.
The viscoelastic was removed from under the lens . The rest of the viscoelastic was removed to prevent increased IOP post op. The center of the lens was aligned to le Purnkinje reflex. Lidocaine and miostat was placed into the anterior chamber to decrease the pupil size and the alignment again rechecked. The would was check fro leaking and none noted with the Weckcel.
Would anybody be able to check my surgery CPT for this. This is my first time doing eye surgery.
66982, 67255, 66740
The site of surgery was properly noted and marked at the right side. The patient was placed with preop dilation drops into the right eye,.
Femtolaser was used to initially do the capsulotomy and breaking of the lens into pieces. While patient is sitting up on the stretcher, they first marked at 180 degrees in the left eye after placing proparacaine drops using the robomarker. The patient is then placed in supine position and the laser patient interface device , PID, placed on the left eye and when suction is attained, it is filled with water. The laser is docked onto the PID and locked. The laser now controls all the other processes until it allows me to step on the pedal and perform the laser for about 15 seconds. It automatically disengages the eye once finished and terminates the process. The patient is now ready to be prepped and draped for surgery. The rhexis could only be 4.4mm since the pupil would not dilate further from previous trauma at an explosion in a chemical factory and injured this eye .
In the operating room, the patient was prepped and draped in the usual sterile ophthalmic manner. IV sedation was given. More verbal anesthesia was also given. The lid speculum was placed in the right eye to be operated on. Lidocaine jelly 4% was placed initially on the surface of the cornea and the conjunctiva to keep the corneal surfacer moist and smooth to alleviate any discomfort. Pressure was to be expected, and the patient was verbally told this during the procedure and irrigation of BSS was to be expected throughout, and the patient understood. The sideport incision was made with the supersharp straight blade. Injection of lidocaine preservative free was done intracamerally. Air was placed prior to injecting the tryphan blue. This was immediately irrigated with BSS. The rhexis was removed with a Utratta forceps a perfectly curvilinear round rhexis 4.4mm round. The anterior chamber was filled with more viscoelastic .
Irrigation of the nucleus to separate the cortical material was performed with a bent cannula with BSS irrigating until the nucleus could be rotated. Omidira and BSS kept the pupil dilated and increased the comfort of the patient. Phacoemulsification of the lens as performed by first debulking and then proceeding with the divide and conquer method. Chopping was also necessary once the femto laser had initially chopped the lens and separation of the pieces was done manually with the phaco tip and Sinsky hook. Prior chopping of the laser made it much more amenable to phacoemusification despite the density of the lens. The CDE was 13.2. The cortical material was removed from the capsular bag using the cortical aspiration setting. The anterior and posterior capsule was polished with the silicone tip.
Prior to leaving the anterior chamber, viscoelastic was placed via the side port to prevent the posterior capsule from forward motion.
The bag was filled with the Provisc and the intraocular lens was inserted into the bag.
Epinsphrine 1:100,000 0.5cc diluted in 500ml of BSS and only 3cc of theis was placed under the iris at the nasal side for the placement of the Allo Flo. The bag was filled with the Provisc and thye DOBOO 22.5D IOL inserted into the bag. The head was tilted to the left and the goniolens was used to visualize the angle with the microscope which showed a n open angle anatomy. The TM and the scleral spur was seen with the gonio lens. Usint the tipo of the provisc , a cyclodialyis cleft was created by dissecting the irirs root from the sceral wall. One to 2 oclock hours of ciliary hours of ciliary body disinsertion were created horizontally at a depth of 4-5mm . Viscocycloplasty was subsequently performed to enlarge the cleft and tamponade any bleeding. Prior to the deployment of the reinforcing bioscaffold the allograft implant is inspected under the microscope for full containment within the cannulated carrier. The carrier was inserted into the cleft until the end of the graft could be seen with a 2mm outside the cleft showing. The holder was then retracted until the purple tubing could be seen. The instrument was removed from the chamber revealing a small stub in the cleft. Some active beleding could be seen and was stopped with Provisc.
The viscoelastic was removed from under the lens . The rest of the viscoelastic was removed to prevent increased IOP post op. The center of the lens was aligned to le Purnkinje reflex. Lidocaine and miostat was placed into the anterior chamber to decrease the pupil size and the alignment again rechecked. The would was check fro leaking and none noted with the Weckcel.