rbrandonisio
New
My surgeon used a burr hole to remove a retained bullet in the forehead area of the skull! Has anyone had to code this that could help me?
Details fo fhe Procedure:
- The patient was brought to the operating room and appropriately identified. He was then received general anesthesia and endotracheal intubation. He was placed on the operative table in supine position with the head lying over a horseshoe clamp. Appropriate prepping and draping were performed. The patient received 2 g of intravenous Ancef and 5 mg/kg of gentamicin intravenously prior to the skin incision. He's wound was extended by 3 mm inferiorly and 3 mm superiorly. The wound was washed thoroughly using antibiotic irrigation. Bovie electro cauterization was used to sharply incise the galea down to the periosteum. A self-retaining retractor was used to open the incision. The wound was cleaned and debrided. The bullet/shrapnel was visualized and identified. The bullet/shrapnel was embedded and stuck into the bone. A match stick drill was used around the bullet/shrapnel and a right frontal bur hole was drilled so that foreign body can be removed. I was then able to remove all that bullet/shrapnel wounds where visible to the naked eye. Skull x-ray was obtained prior to the removal of the bullet/shrapnel wounds and after the removal to make sure that all the metal was removed. Hemostasis was then achieved. A bone cement was used as a form of cranioplasty to seal the burr hole. Antibiotic irrigation was then used again. The inner table was not breached.
The galea was closed with 3-0 Vicryl interrupted. The skin was closed with a running simple 3-0 Monocryl. Bacitracin antibiotics was applied over the incision. Appropriate dressing was then applied. The patient tolerated the procedure without any issues.
Details fo fhe Procedure:
- The patient was brought to the operating room and appropriately identified. He was then received general anesthesia and endotracheal intubation. He was placed on the operative table in supine position with the head lying over a horseshoe clamp. Appropriate prepping and draping were performed. The patient received 2 g of intravenous Ancef and 5 mg/kg of gentamicin intravenously prior to the skin incision. He's wound was extended by 3 mm inferiorly and 3 mm superiorly. The wound was washed thoroughly using antibiotic irrigation. Bovie electro cauterization was used to sharply incise the galea down to the periosteum. A self-retaining retractor was used to open the incision. The wound was cleaned and debrided. The bullet/shrapnel was visualized and identified. The bullet/shrapnel was embedded and stuck into the bone. A match stick drill was used around the bullet/shrapnel and a right frontal bur hole was drilled so that foreign body can be removed. I was then able to remove all that bullet/shrapnel wounds where visible to the naked eye. Skull x-ray was obtained prior to the removal of the bullet/shrapnel wounds and after the removal to make sure that all the metal was removed. Hemostasis was then achieved. A bone cement was used as a form of cranioplasty to seal the burr hole. Antibiotic irrigation was then used again. The inner table was not breached.
The galea was closed with 3-0 Vicryl interrupted. The skin was closed with a running simple 3-0 Monocryl. Bacitracin antibiotics was applied over the incision. Appropriate dressing was then applied. The patient tolerated the procedure without any issues.