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sandy06

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PREOPERATIVE DIAGNOSIS:
1. Status post coronary artery bypass grafting.
2. Sterile dehiscence.

POSTOPERATIVE DIAGNOSES:
1. Status post coronary artery bypass grafting.
2. Sterile dehiscence.

PROCEDURE PERFORMED:
Sternal re-wiring using a Robicsek approach as well as a bilateral
myocutaneous pectoralis muscle advancement flaps and insertion of
irrigation catheters and right pleural chest tube.

SURGEON:

ASSISTANT:
DRAINS:
Right chest tube and two Jackson-Pratt drains.

The patient is status post coronary artery bypass grafting noted to
have sterile dehiscence and was scheduled for sternal re-wiring.

TECHNIQUE:
The patient was taken to the operating room. After being induced,
intubated, prepped and draped in the usual sterile fashion the sternal
incision was reopened, sternal wires were removed. It was noted
that the manubrium was intact however the body of the sternum had
multiple fractures ans bottom sternal wires had torn through sternum.
There were a couple of
fractures on the left and right sides of the hemi sternum body. There
was a little bit of what was felt to be sanguineous fluid that was
sent for cultures but did not look like an infectious process, not murky.
Subsequently dissection was undertaken under the plate of the sternum on both
sides to free up the mediastinum and the heart from the sternum.
Dissection was carried out on both sides and subsequently both pleuras
were entered. The right pleural chest tube was inserted. The patient
already had a left pleural chest tube, however there was some fluid in
the left chest which was also suctioned out. There was no fluid in
the right side however.
The dissection was undertaken without any problems. Subsequently once
both sternal edges were freed from the mediastinum it was possible to
undertake the rewiring. The rewiring was undertaken through the
Robicsek approach meaning wire was placed horizontally from top to bottom
on each side of the sternum and subsequently horizontal mattress and
single wires were placed for total of 9 wires on both sides of the
sternum to reapproximate the two parts together. Prior to doing so and closing the
sternum a red rubber catheter was placed in the mediastinum as well as
a mediastinal chest tube. Subsequently due to the adhesions and the
inflammatory process since the patient had this surgery about 10 days
prior an advancement flap of the myocutaneous pectoralis area was
undertaken on both sides in order to bring the tissues over the
sternum without any tension on them. Good hemostasis was felt to be
in order in both flaps and subsequently two drains were placed, one
under each flap. The muscle and fascial layers were then closed with
interrupted 2-0 Vicryl and then one layer of subcutaneous tissue was
closed with 0-Vicryl in continuous fashion and the skin was closed
with 4-0 monofilament. The patient was transferred intubated back to
the intensive care unit on the irrigation protocol and the drains to
suction.

Can someone please give me some insight on this report, I'm having such a difficult time coding this, the only code I came up with so far is Px Code 15734 for the Myocutaneous Flap
 
32551 - chest tube - I believe

21750 - Sternal closure for dehiscence

with 78 modifier if still in 90-day global.

I believe you can bill the 32551 since it's not included but I can't find the exact 'rules' on when you can or cannot bill it. If I'm am incorrect, someone please point that out. Thanks.

HTH

HTH
 
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