Procedures:
1. Fluorescein cerebrospinal fluid fistulography
2. Right fascia lata graft harvest
3. Transnasal transphenoidal exploration of CSF fistula and repair of defect diaphragma sellae.
4. Bilateral nasal packing
Description for Procedure 3:
...Under microscopic magnification, handheld speculum was placed in to identify the defect in the anterior wall of the sellae. A Hardy speculum was then placed in to provide this same exposure. The necrotic material and swollen mucosa were seen in the opening into the sella. This was debridedwith a small pituitary rongeur and bayonet forceps. Removal of necrotic material was continued until the spnenoid sinus was clean. The opening into the sella was clearly seen posteriorly. There was pulsatile flow of the flurorescein stained cerebrospinal fluid that appeared to orginiate anteriorly and superiorly as expected from the preoperative studies. Suction was used until the sella was relatively dry. What appeared to be remaining pituitary tissue was seen posteriorly and to the left. The portions of the fascia lata graft were then cut approximately 1 cm on each side. these were sen together in the center with a 4-0 Nurolon suture. The 2-layer graft thus created was then placed into the sella with the upper most stamp of fascia lata placed through the defect in the diaphragma sellae although lower one remained inside the sella. While this was held into position, fat and fibrin glue were added below it in the sella. An additional fat graft previously taken was then placed underneath the fascia lata graft. Additional glue was placed over this. Finally, several layers of Surgical and fibrin glue were placed within the sphenoid sinus...
Code for Proce 3: 61618
Code for Proc 1: ??
Pls help with the code for Proc 3 and Proc 1.
thx
ken
1. Fluorescein cerebrospinal fluid fistulography
2. Right fascia lata graft harvest
3. Transnasal transphenoidal exploration of CSF fistula and repair of defect diaphragma sellae.
4. Bilateral nasal packing
Description for Procedure 3:
...Under microscopic magnification, handheld speculum was placed in to identify the defect in the anterior wall of the sellae. A Hardy speculum was then placed in to provide this same exposure. The necrotic material and swollen mucosa were seen in the opening into the sella. This was debridedwith a small pituitary rongeur and bayonet forceps. Removal of necrotic material was continued until the spnenoid sinus was clean. The opening into the sella was clearly seen posteriorly. There was pulsatile flow of the flurorescein stained cerebrospinal fluid that appeared to orginiate anteriorly and superiorly as expected from the preoperative studies. Suction was used until the sella was relatively dry. What appeared to be remaining pituitary tissue was seen posteriorly and to the left. The portions of the fascia lata graft were then cut approximately 1 cm on each side. these were sen together in the center with a 4-0 Nurolon suture. The 2-layer graft thus created was then placed into the sella with the upper most stamp of fascia lata placed through the defect in the diaphragma sellae although lower one remained inside the sella. While this was held into position, fat and fibrin glue were added below it in the sella. An additional fat graft previously taken was then placed underneath the fascia lata graft. Additional glue was placed over this. Finally, several layers of Surgical and fibrin glue were placed within the sphenoid sinus...
Code for Proce 3: 61618
Code for Proc 1: ??
Pls help with the code for Proc 3 and Proc 1.
thx
ken