Wiki Help coding this surgery.

jdibble

True Blue
Messages
798
Location
Mims, Florida
Best answers
0
I am trying to get more opinions on this surgery, so I am re-posting here for help!!!

My surgeon brought this patient to the OR for what he thought was a sebaceous cyst, but turned out to be a traumatic pseudoaneurysm of the left eyebrow. I am unsure on how to code this!! I've come up with either 37609 -(which I am not sure of since he does not say temporal artery) or unlisted code 37799. And diagnosis codes I have either 442.89 or 900.89. The note is below.

PREOPERATIVE DIAGNOSIS: Sebaceous cyst of left eyebrow.

POSTOPERATIVE DIAGNOSIS: Traumatic pseudoaneurysm of left eyebrow.

OPERATION: Repair of traumatic pseudoaneurysm of left eyebrow.

FINDINGS: This was initially thought to be a recurrent sebaceous cyst with an obvious skin pore that had been incised and drained previously. At the time of the surgery, however, with the patient in the supine position, this was palpated and was clearly found to be pulsatile. Postoperative ultrasound revealed no obvious residual pseudoaneurysm. This measured approximately 2.5 cm

PROCEDURE IN DETAIL: The patient was taken to the operating room, and after the induction of satisfactory general LMA anesthesia, was prepped and draped in the usual sterile fashion in the supine position. Palpating the lesion revealed that this was pulsatile and at that point, the lesion was evaluated by Doppler and compression to see where the feeding vessel would be. This appeared to be laterally. Although, the pseudoaneurysm did appear to retrograde fill from medially over the left eyebrow. An elliptical incision was created, preserving the eyebrow, carried down through skin and subcutaneous tissue. This was extended linearly towards the lateral aspect of the eye and the feeding vessel was identified, skeletonized and ligated, using multiple #3-0 Vicryl sutures. The aneurysm at this point was not pulsatile. However, it would fill slowly probably through the retrograde vessel. The dome of the pseudoaneurysm was opened and removed with the skin, and the base of the pseudoaneurysm was oversewn using a running #5-0Prolene suture in a "U" in first mattress, then over and over closure. The subcutaneous tissues were closed with #3-0 Vicryl suture. At this point, ultrasound was used to re-evaluate this. There were multiple vessels in the area. However, no evidence of the large pseudoaneurysm remained. There was one area that measured 0.6 mm away from this area that was noted by our radiologist intraoperatively. At this point, the skin was closed using a running #6-0 Prolene suture and a sterile bandage was applied, after the instillation of local anesthesia. The patient tolerated the procedure satisfactorily and returned to recovery in stable condition. All final sponge,
instrument and needle counts correct.

If anyone could tell me if any of the codes I have are correct or fill me in on what I should be using for both CPT and ICD-9 I would greatly appreciate it!!

Please - any ideas would be helpful!! :)
 
Top