iowagirl77
Guru
Do you bill separately for fluorescein dye administration when done during a craniotomy for tumor biopsy/excision? It wasn't for angiography or to confirm vascular flow in a graft/flap so I don't see a code for it. Do you bill this as unlisted, and what would you compare it to? Added an example of part of a surgery that involves this below:
...Preoperative Ancef, Decadron, Keppra, and 200 mg of intravenous fluorescein dye were given.
Initial portion of the procedure was performed under loupe magnification. The incision was injected with 1 percent lidocaine with epinephrine. An 11 blade scalpel was used to make the incision down through skin, orbicularis oculi, down to the pericranium, and the skin was dissected. The tissue was dissected anteriorly, and fishhook retractors were set into place. A 15 blade scalpel was made to incise along the orbital nerve, and this was extended up medial to the supraorbital nerve and extended laterally. The pericranium was then flapped down inferiorly. Dissection was taken down through the temporalis fascia and muscle as well. A 4 mm cutting bur and the Stryker drill was then used to make a single burr hole underneath the superior temporal line. The dura was dissected using upangled curette, followed by Woodson dental. Router bit was then used to turn the circular craniotomy with care taken to avoid access into the frontal sinus. The orbitotomy was performed, drilling down flat to the surface of the orbit. The wound was copiously irrigated with saline irrigation. Epidural hemostasis was obtained using FloSeal and cottonoid patties. The microscope confirmed changes anterior to the resection cavity. A 15 blade scalpel was used to incise the dura and Metzenbaum scissors to extend the opening in a C-shaped fashion and flapped down inferiorly with 4-0 Nurolon sutures. Medially, webbing along the resection cavity was incised and cut sharply, allowing for further CSF to egress and brain relaxation. The microscope was brought in for illumination magnification and microsurgical technique. We performed exploration around the area of the tumor, and there were multiple regions disconnecting the space of concerning region for tumor. Initially, anteromedially was the area concerning for hemorrhagic tumor. Under fluorescein dye administration, this was noted to be brightly adhered, concerning for tumor. The capsule was cauterized and then cut sharply using microscissors. Under microscopic guidance, the entire tumor was debulked. Tissue was sent for frozen specimen, which returned concerning for glial neoplasm, grade unknown. As such, we continued the dissection to decompress this region, to obtain additional tissue for diagnosis. We continued circumferentially dissecting and tissue was sent for permanent pathology. We turned our attention next. Once this was done, hemostasis was obtained additionally as I went posteriorly and superiorly towards the right dissection of the lesion. Hematoma was resected and removed. We then turned our attention posteromedially on the left to the region of the nonenhancing tissue. This was cauterized, cut sharply, and opened, and soft abnormal-appearing tissue was noted. On fluorescein imaging, there was light fluorescein enhancement, but mild compared to the contrast-enhancing section. This tissue was further debulked...
Thanks!
...Preoperative Ancef, Decadron, Keppra, and 200 mg of intravenous fluorescein dye were given.
Initial portion of the procedure was performed under loupe magnification. The incision was injected with 1 percent lidocaine with epinephrine. An 11 blade scalpel was used to make the incision down through skin, orbicularis oculi, down to the pericranium, and the skin was dissected. The tissue was dissected anteriorly, and fishhook retractors were set into place. A 15 blade scalpel was made to incise along the orbital nerve, and this was extended up medial to the supraorbital nerve and extended laterally. The pericranium was then flapped down inferiorly. Dissection was taken down through the temporalis fascia and muscle as well. A 4 mm cutting bur and the Stryker drill was then used to make a single burr hole underneath the superior temporal line. The dura was dissected using upangled curette, followed by Woodson dental. Router bit was then used to turn the circular craniotomy with care taken to avoid access into the frontal sinus. The orbitotomy was performed, drilling down flat to the surface of the orbit. The wound was copiously irrigated with saline irrigation. Epidural hemostasis was obtained using FloSeal and cottonoid patties. The microscope confirmed changes anterior to the resection cavity. A 15 blade scalpel was used to incise the dura and Metzenbaum scissors to extend the opening in a C-shaped fashion and flapped down inferiorly with 4-0 Nurolon sutures. Medially, webbing along the resection cavity was incised and cut sharply, allowing for further CSF to egress and brain relaxation. The microscope was brought in for illumination magnification and microsurgical technique. We performed exploration around the area of the tumor, and there were multiple regions disconnecting the space of concerning region for tumor. Initially, anteromedially was the area concerning for hemorrhagic tumor. Under fluorescein dye administration, this was noted to be brightly adhered, concerning for tumor. The capsule was cauterized and then cut sharply using microscissors. Under microscopic guidance, the entire tumor was debulked. Tissue was sent for frozen specimen, which returned concerning for glial neoplasm, grade unknown. As such, we continued the dissection to decompress this region, to obtain additional tissue for diagnosis. We continued circumferentially dissecting and tissue was sent for permanent pathology. We turned our attention next. Once this was done, hemostasis was obtained additionally as I went posteriorly and superiorly towards the right dissection of the lesion. Hematoma was resected and removed. We then turned our attention posteromedially on the left to the region of the nonenhancing tissue. This was cauterized, cut sharply, and opened, and soft abnormal-appearing tissue was noted. On fluorescein imaging, there was light fluorescein enhancement, but mild compared to the contrast-enhancing section. This tissue was further debulked...
Thanks!