dtruelson
Guest
I believe 11606 is correct, but is the ICD bundled into the excision? Should I use a modifier? I've been coding these a long time and have never come across this. Any help would be wonderful!!!
Procedure(s) Performed: Procedure(s) (LRB):
ICD EXTRACTION W/ SURGICAL ONCOLOGY (N/A)
ICD EXTRACTION (N/A)
Wide excision malignant melanoma CPT 11606
Anesthesia Type: Monitor Anesthesia Care
Fluid Totals: I/O this shift:
03/19 0600 - 03/19 2259
In: 600 (7.8 mL/kg) [I.V.:600]
Out: 358 (4.7 mL/kg) [Urine:350; Blood:8]
Net: 242
Weight: 76.7 kg
Estimated Blood Loss: 3 mL
Specimens to Pathology: Skin lesion
Temporary Implants:
Packing:
Patient Condition: good
Indications: Malignant melanoma
Findings (Including unexpected complications): 2.5 cm lesion overlying right chest.
Description of Procedure:
Procedures
Wound vacuum dressing closure
Indications --Male with new diagnosis of melanomaof the left upper chest directly above the area of his AICD device. He was counseled to undergo wide excision. We had a long discussion on the benefit of sentinel lymph node biopsy. Due to his age, it is appropriate to consider avoiding the lymph node biopsy as the resultant information would not change the overall plan for the patient. We considered all options, however the patient ultimately could not tolerate general anesthesia due to his cardiac status and we felt that excision alone could be performed with minimal anesthesia whilst the lymph node would require general anesthesia. He was evaluated by Cardiology and treated for infection. It was therefore felt that the best plan was for excision alone under local anesthesia would be most appropriate at the time of his AICD device would be appropriate. This was decided under guidance of the Cardiology team and Surgical Oncology.
Description of Procedure:
The patient was identified in the EP lab area by Dr. ____. The procedure was once again reviewed and informed consent was assured for wide local excision of malignant skin lesion with placement of a Vacuum dressing. he was minimally sedated without difficulty. The patient was positioned appropriately. The chest wall was then prepped and draped in a sterile fashion with Chloroprep. An official Time Out was performed which revealed the patient's name, date of birth, procedure, indication, allergies, and need for antibiotics and subcutaneous heparin. All staff were indicated by name.
The melanoma was noted by the team. A 2-cm margin was marked from the edge of the scar based on the primary Breslow depth. A mixture of 1% Lidocaine with Epinephrine and 0.5% Marcaine without epinephrine was injected along the planned excision site. A 15-blade scalpel was used to incise the skin along the marked region and electrocautery used to dissect to the underlying fascia circumferentially. Small blood vessels were cauterized or tied with 3-0 Vicryl suture as necessary. The specimen was marked prior to complete resection. The skin and subcutaneous tissue were then dissected off the entire muscular fascia and specimen sent for permanent section. The final excision specimen measured 6.5 x 8 cm at the conclusion which included the specimen and the margin of 2-cm.
The wound was irrigated until the effluent clear. Bleeding points were coagulated using electrocautery. The AICD was part of the specimen and the Cardiology team and I worked to separate the AICD from the specimen. The leads were carefully freed and cut with scissors and retracted into the wound. See separate note. The circular defect could not be closed. A skin graft would be required and the discussion was for vacuum dressing. Due to the need again for general anesthesia and the presence of current infection, we planned for vacuum dressing alone with closure by secondary intention and consideration of delayed skin graft depending on the patient's progress.
A wound vacuum dressing was applied with measurement of 6.5 x 7 cm.
Procedure(s) Performed: Procedure(s) (LRB):
ICD EXTRACTION W/ SURGICAL ONCOLOGY (N/A)
ICD EXTRACTION (N/A)
Wide excision malignant melanoma CPT 11606
Anesthesia Type: Monitor Anesthesia Care
Fluid Totals: I/O this shift:
03/19 0600 - 03/19 2259
In: 600 (7.8 mL/kg) [I.V.:600]
Out: 358 (4.7 mL/kg) [Urine:350; Blood:8]
Net: 242
Weight: 76.7 kg
Estimated Blood Loss: 3 mL
Specimens to Pathology: Skin lesion
Temporary Implants:
Packing:
Patient Condition: good
Indications: Malignant melanoma
Findings (Including unexpected complications): 2.5 cm lesion overlying right chest.
Description of Procedure:
Procedures
Wound vacuum dressing closure
Indications --Male with new diagnosis of melanomaof the left upper chest directly above the area of his AICD device. He was counseled to undergo wide excision. We had a long discussion on the benefit of sentinel lymph node biopsy. Due to his age, it is appropriate to consider avoiding the lymph node biopsy as the resultant information would not change the overall plan for the patient. We considered all options, however the patient ultimately could not tolerate general anesthesia due to his cardiac status and we felt that excision alone could be performed with minimal anesthesia whilst the lymph node would require general anesthesia. He was evaluated by Cardiology and treated for infection. It was therefore felt that the best plan was for excision alone under local anesthesia would be most appropriate at the time of his AICD device would be appropriate. This was decided under guidance of the Cardiology team and Surgical Oncology.
Description of Procedure:
The patient was identified in the EP lab area by Dr. ____. The procedure was once again reviewed and informed consent was assured for wide local excision of malignant skin lesion with placement of a Vacuum dressing. he was minimally sedated without difficulty. The patient was positioned appropriately. The chest wall was then prepped and draped in a sterile fashion with Chloroprep. An official Time Out was performed which revealed the patient's name, date of birth, procedure, indication, allergies, and need for antibiotics and subcutaneous heparin. All staff were indicated by name.
The melanoma was noted by the team. A 2-cm margin was marked from the edge of the scar based on the primary Breslow depth. A mixture of 1% Lidocaine with Epinephrine and 0.5% Marcaine without epinephrine was injected along the planned excision site. A 15-blade scalpel was used to incise the skin along the marked region and electrocautery used to dissect to the underlying fascia circumferentially. Small blood vessels were cauterized or tied with 3-0 Vicryl suture as necessary. The specimen was marked prior to complete resection. The skin and subcutaneous tissue were then dissected off the entire muscular fascia and specimen sent for permanent section. The final excision specimen measured 6.5 x 8 cm at the conclusion which included the specimen and the margin of 2-cm.
The wound was irrigated until the effluent clear. Bleeding points were coagulated using electrocautery. The AICD was part of the specimen and the Cardiology team and I worked to separate the AICD from the specimen. The leads were carefully freed and cut with scissors and retracted into the wound. See separate note. The circular defect could not be closed. A skin graft would be required and the discussion was for vacuum dressing. Due to the need again for general anesthesia and the presence of current infection, we planned for vacuum dressing alone with closure by secondary intention and consideration of delayed skin graft depending on the patient's progress.
A wound vacuum dressing was applied with measurement of 6.5 x 7 cm.