AlaskanCoder
Guru
Prodedure in Detail: The patient was taken to the operating room. She was prepped and draped in the standard manner. A mid sternotomy was performed. The anterior, superior, mediastinal fat and thymus were identified. A meticulous dissection was carried out, completely mobilizing the thymus including the lower right and left horns. The right upper horn was relatively small. However, the left lobe of the thymus was quite large and there was a long extension into the neck. All the tissue was carefully mobilized and dissected. The innominate vein was carefully preserved and all adjacent tissue was removed.
The dissection was carried out as close as deemed safe to both the left and right phrenic nerves. The pleural spaces had been entered from the beginning of the case, and both phrenic nerves were clearly identified.
As we mobilized the tissue, we found an area that was intimately adherent to the anterior pericardial sac, and a pericardial excision was carried out leaving a defect of approximately 2 x 2 inches. Careful hemostasis was obtained upon completion of the excision. The pericardial defect was repaied with a Gore-Tex membrane. Another Gore-Tex membrane piece was used to completely cover the innominate vein, separating it from the posterior sternal table. Multiple stitiches of 4-0 Prolene were taken tacking the patches down to prevent migration.
Three #24 Blake chest tubes were placed, 1 each to the pleural spaces and 1 of them to the anterior mediastinum.
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So, I am coding the Thymectomy as 60521. But, my question is, are the Gore-Tex grafts included in the thymectomy or are they separately reportable. If they are separately reportable, any suggestion on the code(s) for the repairs? Really appreciate any and all help with this one.
TIA,
Karen Hill, CPC, CPB, CPMA
The dissection was carried out as close as deemed safe to both the left and right phrenic nerves. The pleural spaces had been entered from the beginning of the case, and both phrenic nerves were clearly identified.
As we mobilized the tissue, we found an area that was intimately adherent to the anterior pericardial sac, and a pericardial excision was carried out leaving a defect of approximately 2 x 2 inches. Careful hemostasis was obtained upon completion of the excision. The pericardial defect was repaied with a Gore-Tex membrane. Another Gore-Tex membrane piece was used to completely cover the innominate vein, separating it from the posterior sternal table. Multiple stitiches of 4-0 Prolene were taken tacking the patches down to prevent migration.
Three #24 Blake chest tubes were placed, 1 each to the pleural spaces and 1 of them to the anterior mediastinum.
*****************************************************************
So, I am coding the Thymectomy as 60521. But, my question is, are the Gore-Tex grafts included in the thymectomy or are they separately reportable. If they are separately reportable, any suggestion on the code(s) for the repairs? Really appreciate any and all help with this one.
TIA,
Karen Hill, CPC, CPB, CPMA