Any help would be greatly appreciated!
"The incision was taken down through the subcutaneous tissue and the fascia. Intercostal muscles were divided. The patient had massive adhesions from the previous VATS lobectomy. The adhesions were taken down using sharp and blunt dissection. Also we used electrocautery Bovie in order to take down the adhesions. When the adhesions were taken down on the anterolateral surface of the right lung, the rib retractor was placed in position and the ribs were spread. Following that, we carried dissection of the lung from the posterior aspect of the chest, again using electrocautery Bovie and sharp and blunt dissection. In the apex, the heart was stuck right at the area where the tumor was, and it was not clear for me whether the tumor was going to the parietal pleura. So, the apex was dissected extra-pleurally with the pleura and partially with the periosteum of the anterior aspect of the second rib. Following that, we got down to the hilum, the superior branch of the pulmonary vein was dissected all the way around, stapled and transected with Endo GIA vascular load stapler. The venous branch going to the middle lobe was preserved. Following that, the fissure between the upper and middle lobe was develpoed using the Endo GIA thick tissue stapler with 3 loads. The upper lobe bronchus was identified, dissected all the way around and the TIA 30 stapler was applied on the bronchus. After stapler was closed, the ventilation showed that the middle lobe ventilated properly, so the stapler was fired and the bronchus was transected. Following that, the posterior aspect of the hilum was dissected using electrocautery Bovie. The remains of the minor fissure between the upper and middle lobe were divided isingthe Endo GIA 60 thick tissue stapler. The specimen was removed and sent for frozen section."
I was going to bill a 32480 and 32124 for the adhesions but I'm unsure if the 32480 covers the pleurectomy and partial removal of the periosteum of the second rib. A 32320 covers decortication and parietal pleurectomy but I don't think this fits what he did. Any ideas?
"The incision was taken down through the subcutaneous tissue and the fascia. Intercostal muscles were divided. The patient had massive adhesions from the previous VATS lobectomy. The adhesions were taken down using sharp and blunt dissection. Also we used electrocautery Bovie in order to take down the adhesions. When the adhesions were taken down on the anterolateral surface of the right lung, the rib retractor was placed in position and the ribs were spread. Following that, we carried dissection of the lung from the posterior aspect of the chest, again using electrocautery Bovie and sharp and blunt dissection. In the apex, the heart was stuck right at the area where the tumor was, and it was not clear for me whether the tumor was going to the parietal pleura. So, the apex was dissected extra-pleurally with the pleura and partially with the periosteum of the anterior aspect of the second rib. Following that, we got down to the hilum, the superior branch of the pulmonary vein was dissected all the way around, stapled and transected with Endo GIA vascular load stapler. The venous branch going to the middle lobe was preserved. Following that, the fissure between the upper and middle lobe was develpoed using the Endo GIA thick tissue stapler with 3 loads. The upper lobe bronchus was identified, dissected all the way around and the TIA 30 stapler was applied on the bronchus. After stapler was closed, the ventilation showed that the middle lobe ventilated properly, so the stapler was fired and the bronchus was transected. Following that, the posterior aspect of the hilum was dissected using electrocautery Bovie. The remains of the minor fissure between the upper and middle lobe were divided isingthe Endo GIA 60 thick tissue stapler. The specimen was removed and sent for frozen section."
I was going to bill a 32480 and 32124 for the adhesions but I'm unsure if the 32480 covers the pleurectomy and partial removal of the periosteum of the second rib. A 32320 covers decortication and parietal pleurectomy but I don't think this fits what he did. Any ideas?