Wiki Endoscopic Expanded Endonasal Approach for resection of sellar/suprasellar tumor

[carlystur]

I am a Pro-fee neuro e/m coder that is being asked to code a surgery since our outsourced billing/coding company is late to get to it. Dr. F and Dr. T are not with our practice.

I'm thinking this should just be 62165-62, but let me know your thoughts as I haven't really touched surgeries that much since I took the neuro coding course several years ago. Please let me know if I've missed anything.

The patient was identified in the preoperative holding area by the anesthesia and operating room staff. The patient was transported to the operating room. The patient underwent induction line placement and intubation by anesthesia. The neurophysiologist placed the neuromonitoring wires. The patient was placed supine on the operating room table. The neuronavigation software was registered to the patient's head. A preoperative timeout was performed. The patient was prepped and draped in usual sterile fashion. My partner Dr. F gained access and took a nasal septal flap for closure at the end of the case. The steps will be dictated in a separate operative report.

The sellar and infra chiasmatic dura was opened sharply with a retractable knife. The dura was resected away. The tumor capsule was infiltrated and several small pieces were sent for specimen. The floor of the sella turcica was inspected for any tumor and all tumor was removed from the floor in the lateral inferior walls. Once the tumor was internally debulked and the sellar compartment the diaphragm did begin to fall. Tumor capsule was seen to be stuck to falling arachnoid which was dissected off of the arachnoid. Laterally on the right side the tumor was taken very carefully off of the pituitary gland which was left intact grossly. Further bone was removed more superiorly just inferior to the optic chiasm in order to view the tumor that had moved suprasellar and posteriorly towards the third ventricle. I requested the assistance of my neurosurgery colleague Dr. T who very kindly scrubbed in to provide additional assistance with these maneuvers. With his assistance the suprasellar portion of the tumor was internally debulked until the optic nerves were able to be visualized through the arachnoid. There was some small pieces that were stuck to the arachnoid which I felt would not impact the overall outcome short or long-term for the patient and would provide increased risk for catastrophic injury to neurologic structures. I elected to leave this small amount of tumor alone. Hemostasis was achieved with warm irrigation as well as Surgiflo.

A right fascia lata graft was harvested by my partner Dr. F which will be dictated in a separate operative report. This graft was placed inside of the dural defect as CSF was encountered during tumor resection as expected. He then placed the nasoseptal flap along with a hydrogel matrix for additional coverage which will also be dictated in separate operative report. This concluded my portion of the operation and the remainder will be dictated by Dr. F in a separate operative report. There were no apparent intraoperative complications during this operation. I performed all critical neurosurgical portions of this operation. All sponge needle and instrument counts were correct prior to the final commencement of the operation. The patient was turned back over to anesthesia for reversal extubation and wake up after the drapes were removed. There were no intraoperative neuromonitoring changes during this operation. The patient was transported out of the operating room in stable condition.