Go morning all,
I'm having a time with the DX code for a shunt removal without replace surgery. My provider advised that it was due to appendicitis and not infection of the shunt, however had to be removed due to abdominal abscess. Which dx code would you use? here's a cop of the report: Operation 1. Removal of VP shunt without replacement
PROCEDURE IN DETAIL: The patient was identified in the holding area and brought back to operating room 9where they were handed over to Anesthesia for a smooth induction of general anesthesia, appropriate IV access, and foley was placed on the floor. Patient was laid supine on a regular operating room table and turned 90 degrees away from anesthesia with the rightside exposed and a shoulder roll placed underneath the shoulder making the head parallel to the ground. This exposed the occipital area and verifying there is no pressure on the ear or the globes of the eyes. The arm was then placed on the side and taped into place but still giving good visualization of the abdominal area. The posterior entry point was identified by measuring 7 cm above the inion and 3 to 4 cm lateral. Hair was then clipped with clippers to provide a path from the opening location to the neck for tunneling. Once in position, the area was prepped and draped in a sterile fashion using Betadine paint and scrub on the head and ChloraPrep on the abdominal area allowing it to dry to manufacturer specification. Once draped and dried, timeout was performed according to hospital protocol and SCIP protocol followed with Ancef and SCDs.
OPENING: Focus started with a head infusing the skin with local anesthetic. A 10 blade was used to make an opening in a linear fashion at the previous incision. Bovie electrocautery was used dissect down to the catheter and the previous bur hole. Once this was exposed then subcutaneous tissue was dissected bluntly until the valve was identified and an opening was made large enough for the valve to slide through. Once this was completed and the catheter at the clavicle was then identified and was ligated. The distal portion of the catheter was then removed and pulled away from the surgical field and discarded. The remaining portion of the catheter that was sterilized and prepped into the surgical field was then left available. Focus turned towards the valve and the cranial portion. The distal portion of the catheter was then pulled from the subcutaneous tissue easily without obstruction. All of the catheter was removed without problem. And focus turned towards the ventricular portion and this was easily removed from the ventricle and CSF flowed and there was no sign of bleeding or other issues. The scar tissue was then sutured closed with a 2-0 Vicryl to avoid leakage. And then closure commenced.
CLOSURE: The incision on the head was closed with 2-0 Vicryl in the galea followed by 3-0 Monocryl Quill suture in the subcutaneous tissue. The incision on the clavicle was closed using absorbable sutures and the silk tie that was there previously was removed. Steri-Strips and Mastisol were applied and sterile dressing applied. Patient was then turned back towards anesthesia extubated, transferred to an bed and taken to PACU in stable condition. There were no complications noted for anesthesia or surgery during the case and counts are correct x2 at the end of the case.
I'm having a time with the DX code for a shunt removal without replace surgery. My provider advised that it was due to appendicitis and not infection of the shunt, however had to be removed due to abdominal abscess. Which dx code would you use? here's a cop of the report: Operation 1. Removal of VP shunt without replacement
PROCEDURE IN DETAIL: The patient was identified in the holding area and brought back to operating room 9where they were handed over to Anesthesia for a smooth induction of general anesthesia, appropriate IV access, and foley was placed on the floor. Patient was laid supine on a regular operating room table and turned 90 degrees away from anesthesia with the rightside exposed and a shoulder roll placed underneath the shoulder making the head parallel to the ground. This exposed the occipital area and verifying there is no pressure on the ear or the globes of the eyes. The arm was then placed on the side and taped into place but still giving good visualization of the abdominal area. The posterior entry point was identified by measuring 7 cm above the inion and 3 to 4 cm lateral. Hair was then clipped with clippers to provide a path from the opening location to the neck for tunneling. Once in position, the area was prepped and draped in a sterile fashion using Betadine paint and scrub on the head and ChloraPrep on the abdominal area allowing it to dry to manufacturer specification. Once draped and dried, timeout was performed according to hospital protocol and SCIP protocol followed with Ancef and SCDs.
OPENING: Focus started with a head infusing the skin with local anesthetic. A 10 blade was used to make an opening in a linear fashion at the previous incision. Bovie electrocautery was used dissect down to the catheter and the previous bur hole. Once this was exposed then subcutaneous tissue was dissected bluntly until the valve was identified and an opening was made large enough for the valve to slide through. Once this was completed and the catheter at the clavicle was then identified and was ligated. The distal portion of the catheter was then removed and pulled away from the surgical field and discarded. The remaining portion of the catheter that was sterilized and prepped into the surgical field was then left available. Focus turned towards the valve and the cranial portion. The distal portion of the catheter was then pulled from the subcutaneous tissue easily without obstruction. All of the catheter was removed without problem. And focus turned towards the ventricular portion and this was easily removed from the ventricle and CSF flowed and there was no sign of bleeding or other issues. The scar tissue was then sutured closed with a 2-0 Vicryl to avoid leakage. And then closure commenced.
CLOSURE: The incision on the head was closed with 2-0 Vicryl in the galea followed by 3-0 Monocryl Quill suture in the subcutaneous tissue. The incision on the clavicle was closed using absorbable sutures and the silk tie that was there previously was removed. Steri-Strips and Mastisol were applied and sterile dressing applied. Patient was then turned back towards anesthesia extubated, transferred to an bed and taken to PACU in stable condition. There were no complications noted for anesthesia or surgery during the case and counts are correct x2 at the end of the case.