jdibble
True Blue
I am not sure if I have this coded correctly. I have used 27047 for the lipoma removal, however I am not sure if there is more to this procedure than that.
PREOPERATIVE DIAGNOSIS: Left inguinal mass.
POSTOPERATIVE DIAGNOSIS: Left inguinal mass.
OPERATION: Left inguinal exploration, excision of lipoma, and buttress of
external ring.
SPECIMEN: Lipoma.
FINDINGS: Left groin lipoma with laxity at external ring.
INDICATIONS FOR PROCEDURE: The patient is a 36-year-old woman who had been
complaining of a lump in her left groin in the parapubic area with pain that
radiated down her medial thigh and around to her back. The patient had had an
ultrasound which did not reveal it. With the worsening pain and discomfort she
wanted it explored or removed. It was difficult on exam to tell whether it was
a hernia or just a lipoma since it was tender and not reducible. So, it was
discussed with the patient the possible risks, benefits, and complications of
excision of lipoma or repair of left inguinal hernia. She understood and agreed
to proceed with surgery.
DESCRIPTION OF PROCEDURE: The patient was brought to the OR on 01/06/16 and
placed on the table in supine position. She had undergone a TAP block in preop
hold. After general anesthesia she was prepped and draped in sterile fashion.
An incision was made in the left inguinal region and carried down through the
subcutaneous tissue. This was just above the mass in the normal position of
hernia repair. The dissection down through Scarpa's fascia was undertaken and
blunt dissection down to the external oblique aponeurosis was undertaken.
Palpation along the muscle was undertaken and did not appear to have any
defects. However, there was still noted to be a lump on the skin surface so
dissection was undertaken above the Scarpa's fascia into the subcutaneous tissue
and revealed the globular mature fat which was noted to be intertwined in the
connective tissue. This was dissected out as best possible and then removed.
It was not one continuous lobule, it was multiple lobules and they were taken
out in pieces. Then blunt dissection was undertaken along this subcutaneous
area within the connective tissue. Adequate hemostasis was obtained with
electro Bovie cautery to control the superficial veins that had been cauterized
and ligated. Further inspection was undertaken under the area where the lipoma
had been removed. When it was noted that the external ring was right there it
did not have any protruding structures, however it appeared to be a little lax
so a 0 Vicryl stitch was placed to kind of buttress and reinforce it. The area
was then irrigated profusely with saline and no other abnormalities were noted.
Then it was injected with 0.5% Marcaine. The Scarpa's fascia was then
approximated with interrupted 3-0 Vicryl stitches. The subcutaneous tissue was
approximated with interrupted 3-0 Vicryl stitches and the skin approximated with
running 4-0 Monocryl subcuticular stitch. The patient tolerated the procedure
well and was taken to the recovery room in stable condition. All counts correct
at the end of the case.
Any suggestions would be great!!
Thanks,
PREOPERATIVE DIAGNOSIS: Left inguinal mass.
POSTOPERATIVE DIAGNOSIS: Left inguinal mass.
OPERATION: Left inguinal exploration, excision of lipoma, and buttress of
external ring.
SPECIMEN: Lipoma.
FINDINGS: Left groin lipoma with laxity at external ring.
INDICATIONS FOR PROCEDURE: The patient is a 36-year-old woman who had been
complaining of a lump in her left groin in the parapubic area with pain that
radiated down her medial thigh and around to her back. The patient had had an
ultrasound which did not reveal it. With the worsening pain and discomfort she
wanted it explored or removed. It was difficult on exam to tell whether it was
a hernia or just a lipoma since it was tender and not reducible. So, it was
discussed with the patient the possible risks, benefits, and complications of
excision of lipoma or repair of left inguinal hernia. She understood and agreed
to proceed with surgery.
DESCRIPTION OF PROCEDURE: The patient was brought to the OR on 01/06/16 and
placed on the table in supine position. She had undergone a TAP block in preop
hold. After general anesthesia she was prepped and draped in sterile fashion.
An incision was made in the left inguinal region and carried down through the
subcutaneous tissue. This was just above the mass in the normal position of
hernia repair. The dissection down through Scarpa's fascia was undertaken and
blunt dissection down to the external oblique aponeurosis was undertaken.
Palpation along the muscle was undertaken and did not appear to have any
defects. However, there was still noted to be a lump on the skin surface so
dissection was undertaken above the Scarpa's fascia into the subcutaneous tissue
and revealed the globular mature fat which was noted to be intertwined in the
connective tissue. This was dissected out as best possible and then removed.
It was not one continuous lobule, it was multiple lobules and they were taken
out in pieces. Then blunt dissection was undertaken along this subcutaneous
area within the connective tissue. Adequate hemostasis was obtained with
electro Bovie cautery to control the superficial veins that had been cauterized
and ligated. Further inspection was undertaken under the area where the lipoma
had been removed. When it was noted that the external ring was right there it
did not have any protruding structures, however it appeared to be a little lax
so a 0 Vicryl stitch was placed to kind of buttress and reinforce it. The area
was then irrigated profusely with saline and no other abnormalities were noted.
Then it was injected with 0.5% Marcaine. The Scarpa's fascia was then
approximated with interrupted 3-0 Vicryl stitches. The subcutaneous tissue was
approximated with interrupted 3-0 Vicryl stitches and the skin approximated with
running 4-0 Monocryl subcuticular stitch. The patient tolerated the procedure
well and was taken to the recovery room in stable condition. All counts correct
at the end of the case.
Any suggestions would be great!!
Thanks,