AKEISTER
Networker
How would you code the following op report? I am leaning towards 65756, 65400
On the day of surgery, the patient was brought back to the operating room placed, in the supine position on the operating room table, and the retrobulbar and O'Brien blocks consisting of the above-noted mixtures were placed. The eye was then prepped and draped in the usual sterile fashion for intraocular surgery, and the operating microscope was brought up into position. A maumenee forceps and a crescent blade were used to size the corneal nodule and remove the central 5 mm of epithelium. Using 0.12 forceps and Wescott scissors, a peritomy was made at the temporal position, and hemostasis was obtained using a bipolar-tipped cautery. A 5 mm scleral tunnel incision was initiated at the temporal position using a super sharp 15-degree blade, paracentesis were placed to the left and right of this using a diamond 1mm paracentesis blade, and Healon was instilled into the anterior chamber. Next, a crescent blade was used to carry the incision forward into clear cornea. Nex,t a corneal marker of size of the donor noted above was marked on the cornea and accentuated with ink marks. A reverse Sinsky hook was then used to score Descemet's for 360 degrees, 1 mm within this marked area. Descemat's was then stripped with the same Sinsky hook. Next, the eye was entered through the scleral and tunnel incision with a 2.75mm metal microkeratome.
The Descemet's membrane specimen was removed from the eye. A Terry scraper was used to scrape the peripheral 1 mm bed of the pre-marked cornea. The wound was then widened to its full 5 mm length with a crescent spoon blade, and a Vicryl suture was placed centrally within the wound. The automated irrigation-aspiration hand tip was then used to remove all Healon completely from the eye. BSS on a cannula was used to deepen the anterior chamber, and Miochol was instilled into the eye constricting the pupil.
Next, attention was turned to the donor table where the corneal scleral rim was inspected. The cap was marked, and the 8 mm donor was then trephined to the size noted above. A thin strip of Healon was placed on the endothelial side of the tissue, and it was then folded using Utrada forceps into a 40/60 taco-shaped configuration.
Attention was then turned back to the recipient were the Vicryl suture was removed. The anterior chamber was then re-deepened, with BSS on a cannula, of each of the paracentesis. Next, the tissue was grasped using Charlie insertion forceps and inserted into the eye with the 40% taco facing posteriorly. Using BSS on the cannula, a graft was positioned gently on the stromal side and moved into position. Next, the anterior chamber was deepened with BSS on a cannula, and air was used to complete the unfolding of the graft. Once sufficient air was in the anterior chamber, the graft was swept atraumatically into perfect position. Additional air was placed into the chamber until firm air-fill was obtained, at which point sweeping maneuvers using the Cindy sweeper were performed. This maneuver was used to sweep fluid from the interface. Once the graft was noted to be in good position and firmly attached, 3 Vicryl sutures were placed in the wound. Additional air was placed, and some additional sweeping was performed until it was felt that all interface fluid had been removed.
Next, tropicamide and phenylephrine drops were placed on the eye, and the graft was left in this position with a full anterior chamber air-fill for ten minutes undisturbed. After the ten minute waiting period, the suture tails were cut short, the knots were rotated and the peritomy was closed using cautery. The patient's head was rotated away from the surgeon, and the air was removed from the anterior chamber using BSS on a cannula until just a small free floating air bubble was present. Next, additional air was placed back into the eye just to overlap the very inner edges of the graft. A good eye pressure was noted, and collagen shield soaked in Ancef, Decadron, and Zymar was placed on the eye. Additionally, Erythromycin ointment was placed on the lid helping to close the lid, and a very light eye patch was placed on the eye under an eye shield.
Thanks
On the day of surgery, the patient was brought back to the operating room placed, in the supine position on the operating room table, and the retrobulbar and O'Brien blocks consisting of the above-noted mixtures were placed. The eye was then prepped and draped in the usual sterile fashion for intraocular surgery, and the operating microscope was brought up into position. A maumenee forceps and a crescent blade were used to size the corneal nodule and remove the central 5 mm of epithelium. Using 0.12 forceps and Wescott scissors, a peritomy was made at the temporal position, and hemostasis was obtained using a bipolar-tipped cautery. A 5 mm scleral tunnel incision was initiated at the temporal position using a super sharp 15-degree blade, paracentesis were placed to the left and right of this using a diamond 1mm paracentesis blade, and Healon was instilled into the anterior chamber. Next, a crescent blade was used to carry the incision forward into clear cornea. Nex,t a corneal marker of size of the donor noted above was marked on the cornea and accentuated with ink marks. A reverse Sinsky hook was then used to score Descemet's for 360 degrees, 1 mm within this marked area. Descemat's was then stripped with the same Sinsky hook. Next, the eye was entered through the scleral and tunnel incision with a 2.75mm metal microkeratome.
The Descemet's membrane specimen was removed from the eye. A Terry scraper was used to scrape the peripheral 1 mm bed of the pre-marked cornea. The wound was then widened to its full 5 mm length with a crescent spoon blade, and a Vicryl suture was placed centrally within the wound. The automated irrigation-aspiration hand tip was then used to remove all Healon completely from the eye. BSS on a cannula was used to deepen the anterior chamber, and Miochol was instilled into the eye constricting the pupil.
Next, attention was turned to the donor table where the corneal scleral rim was inspected. The cap was marked, and the 8 mm donor was then trephined to the size noted above. A thin strip of Healon was placed on the endothelial side of the tissue, and it was then folded using Utrada forceps into a 40/60 taco-shaped configuration.
Attention was then turned back to the recipient were the Vicryl suture was removed. The anterior chamber was then re-deepened, with BSS on a cannula, of each of the paracentesis. Next, the tissue was grasped using Charlie insertion forceps and inserted into the eye with the 40% taco facing posteriorly. Using BSS on the cannula, a graft was positioned gently on the stromal side and moved into position. Next, the anterior chamber was deepened with BSS on a cannula, and air was used to complete the unfolding of the graft. Once sufficient air was in the anterior chamber, the graft was swept atraumatically into perfect position. Additional air was placed into the chamber until firm air-fill was obtained, at which point sweeping maneuvers using the Cindy sweeper were performed. This maneuver was used to sweep fluid from the interface. Once the graft was noted to be in good position and firmly attached, 3 Vicryl sutures were placed in the wound. Additional air was placed, and some additional sweeping was performed until it was felt that all interface fluid had been removed.
Next, tropicamide and phenylephrine drops were placed on the eye, and the graft was left in this position with a full anterior chamber air-fill for ten minutes undisturbed. After the ten minute waiting period, the suture tails were cut short, the knots were rotated and the peritomy was closed using cautery. The patient's head was rotated away from the surgeon, and the air was removed from the anterior chamber using BSS on a cannula until just a small free floating air bubble was present. Next, additional air was placed back into the eye just to overlap the very inner edges of the graft. A good eye pressure was noted, and collagen shield soaked in Ancef, Decadron, and Zymar was placed on the eye. Additionally, Erythromycin ointment was placed on the lid helping to close the lid, and a very light eye patch was placed on the eye under an eye shield.
Thanks