jk2003
Networker
Doctor wants to bill 49010, 10140, and 38900, but the 38900 is for lymp nodes. Can the dye be billed with another code?
The patient is an 89-year-old male who was referred to me for evaluation of a
left groin lymphocele. The patient had undergone a percutaneous placement of
a coronary valve approximately 9 months previously. The patient subsequently
developed a slowly enlarging mass of the left groin which was determined by
noninvasive testing to be consistent with a lymphocele. I discussed with the
patient and his daughter the possibilities for treatment and reconstruction.
I discussed with them the possibility of exploring the groin and possible
need for treatment with flap reconstruction. I also discussed intraoperative
lymphatic mapping in order to try and isolate the leaking lymphatic channels.
All risks, benefits, alternatives and complications were discussed in detail
with the patient who understood these and agreed to surgery and an operative
date was scheduled.
PROCEDURE:
On the date of operation the patient was brought to the operating room and
placed on operating table in the supine position. Noninvasive hemodynamic
monitoring devices were placed on the patient by the Anesthesia team,
intravenous access obtained by the Anesthesia team and a perioperative dose
of antibiotics was given. After induction of general anesthesia and securing
of the airway, the patient was prepped and draped in the usual sterile
fashion.
The operation commenced by entering the left groin through his previous
cutdown site. The lymphocele cavity was entered and several hundred cc of
clear straw-colored fluid was encountered. The lymphocele cavity which had an
anterior component and also then seemed to track deeper posteriorly. 1 cc of
blue dye was injected at the level of the ankle circumferentially in an
effort to map at the lymphatics involved in the leak. After allowing for
10-15 minutes for the lymphazurin blue to travel up the leg, no leaking
lymphatics were identified. The decision was made at this point to further
explore posteriorly in the cavity into the retroperitoneum. A small incision
was made and the dissection into the retroperitoneum was begun. However,
because of the very significant adherence of the posterior wall of the
lymphocele cavity to the vessels in the area, the decision was made to abort
further exploration with plans to return to explore the area in concert with
the vascular surgery service.
At this point the lymphocele cavity was oversewn with several 0 Maxon
sutures. A #10 flat Jackson-Pratt drain was placed through a stab incision to
lie within the obliterated cavity and was secured with a 3-0 nylon suture.
The wound was once again thoroughly irrigated and hemostasis obtained. The
superficial fascia closed with 2-0 Polysorb, the deep layer closed with 3-0
Polysorb and the skin edges were stapled. A sterile dressing was applied. The
patient was awoken, extubated and transferred to the recovery room in stable
condition.
The patient is an 89-year-old male who was referred to me for evaluation of a
left groin lymphocele. The patient had undergone a percutaneous placement of
a coronary valve approximately 9 months previously. The patient subsequently
developed a slowly enlarging mass of the left groin which was determined by
noninvasive testing to be consistent with a lymphocele. I discussed with the
patient and his daughter the possibilities for treatment and reconstruction.
I discussed with them the possibility of exploring the groin and possible
need for treatment with flap reconstruction. I also discussed intraoperative
lymphatic mapping in order to try and isolate the leaking lymphatic channels.
All risks, benefits, alternatives and complications were discussed in detail
with the patient who understood these and agreed to surgery and an operative
date was scheduled.
PROCEDURE:
On the date of operation the patient was brought to the operating room and
placed on operating table in the supine position. Noninvasive hemodynamic
monitoring devices were placed on the patient by the Anesthesia team,
intravenous access obtained by the Anesthesia team and a perioperative dose
of antibiotics was given. After induction of general anesthesia and securing
of the airway, the patient was prepped and draped in the usual sterile
fashion.
The operation commenced by entering the left groin through his previous
cutdown site. The lymphocele cavity was entered and several hundred cc of
clear straw-colored fluid was encountered. The lymphocele cavity which had an
anterior component and also then seemed to track deeper posteriorly. 1 cc of
blue dye was injected at the level of the ankle circumferentially in an
effort to map at the lymphatics involved in the leak. After allowing for
10-15 minutes for the lymphazurin blue to travel up the leg, no leaking
lymphatics were identified. The decision was made at this point to further
explore posteriorly in the cavity into the retroperitoneum. A small incision
was made and the dissection into the retroperitoneum was begun. However,
because of the very significant adherence of the posterior wall of the
lymphocele cavity to the vessels in the area, the decision was made to abort
further exploration with plans to return to explore the area in concert with
the vascular surgery service.
At this point the lymphocele cavity was oversewn with several 0 Maxon
sutures. A #10 flat Jackson-Pratt drain was placed through a stab incision to
lie within the obliterated cavity and was secured with a 3-0 nylon suture.
The wound was once again thoroughly irrigated and hemostasis obtained. The
superficial fascia closed with 2-0 Polysorb, the deep layer closed with 3-0
Polysorb and the skin edges were stapled. A sterile dressing was applied. The
patient was awoken, extubated and transferred to the recovery room in stable
condition.