Dural Tear Repair

mtrandel

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PREOPERATIVE DIAGNOSIS:
Status post repair of dural tear from an extensive instrumented posterior
spine fusion down at another facility with a persistent dural tear.

OPERATION:
Repair of dural tear with a bovine pericardium graft.

PROCEDURE:
The patient was brought back to the operating room, general anesthesia was administered
via endotracheal tube. The patient was given 2 g of Ancef IV antibiotics prior to the start of the
operative procedure. After appropriate timeout the patient had the sutures removed from the skin
from the previous lower part of the incision which was evaluated last Wednesday. The patient then
had the sutures removed from the skin and subcutaneous tissue and then the deep fascia. The patient
was again noted to have leakage from the dural graft repair. At this point the patient has very
friable tissues and not much to sew to and therefore a bovine pericardium was used at this point to
suture the defect. There was no leakage after suturing with this and with Valsalva. This was
performed twice. Following this the patient then had DuraSeal placed over the graft. The patient
then had closure of the fascia with #1 Vicryl in a figure-of-eight suture pattern followed by #1
Vicryl simple continuous type fashion in the posterior spine fascia followed by then 2-0 Vicryl
simple interrupted buried type fashion to close the subcutaneous tissue in multiple layers.

Would this be 63707-78 or 63710-78? The lay description of 63707 includes a graft so I'm confused as to when each code is used. Thanks in advance!
 
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