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foreign body - surgical exploration


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The doctor did a surgical exploration of a painful foreign body which turned out to be an intrathecal pump connector which he removed and and then placed back into the wound. I am looking at 20520 or 20670 but am not sure either is accurate. Thank you for any assistance. PREOPERATIVE DIAGNOSIS: Painful foreign body left sacroiliac region. POSTOPERATIVE DIAGNOSIS: 1. Painful foreign body left sacroiliac region. 2. Painful connecting hardware from intrathecal catheter. SURGICAL PROCEDURE: surgical exploration of left perisacral region and identification of painful intrathecal catheter connector. DESCRIPTION:The patient was seen and examined. The risks, benefits and alternatives this procedure were explained to the patient. The patient understood these and consented to the procedure. Intravenous infusion was begun and perioperative antibiotics administered. The patient was brought to the operating suite and placed in the prone position. He was sterilely prepped and draped in the usual fashion. Skin over the painful left sacral region was visualized in fluoroscopy in multiple planes. The foreign body was visualized using triangulation and the skin overlying infiltrated with 5 ml of 2% lidocaine 25-gauge needle. Dissection was carried down to the foreign body which was eventually grasped with a forceps and pulled to the surface. It was noted to be the intrathecal pump connector that was placed for the patient’s catheter extension at his last pump pocket revision when his pocket was moved from the gluteal to the left lower quadrant region. This area did not become painful for several months postoperatively interestingly. As the patient requires this connector for his analgesia, it was placed back into the wound. The overlying skin and tissue was closed with 2-0 Vicryl and skin staples. The patient was then turned supine and brought to recovery where he was observed an additional hour. There were no early adverse effects.


Denver Colorado
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consider 62350 Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy