herrera4
Guru
can anyone walk me through this op note please
TITLE OF OPERATION: Exploratory thoracotomy with resection of superior segment, right lower lobe and wedge resection, right upper lobe with nodal sampling. An On-Q pain pump was also placed.
DETAILS OF THE PROCEDURE: The patient was brought to the Operating Room and placed in supine position. Following induction of general anesthesia, Foley catheter was placed by nursing staff. He was then placed in left lateral decubitus position on a bean bag with all bony prominences padded. He was prepped and draped in the usual sterile fashion using ChloraPrep. After appropriate time-out, a standard muscle-sparing thoracotomy was carried out through the sixth interspace. Intercostal muscles were divided using Bovie extension. Finochietto retractors were placed, thus giving excellent visualization. The lung deflated nicely with the double lumen tube. Adhesions anteriorly were taken down between the middle lobe and the pericardium. The pulmonary ligament was mobilized and the R9 lymph nodes were sampled. The lower lobe lesion was easily palpable. The upper lobe lesion was somewhat more difficult to palpate. This was wedged out using endo-GIA using the purple loads. The lesion was not easily palpable through the specimen. Accordingly, there was further mobilization of the small pulmonary vein feeding the medial segment of the upper lobe and additional tissue was taken using endo-GIA and passed off the field. Next, the fissure was opened and the pulmonary artery was mobilized. The superior segment of the artery of the lower lobe was mobilized and this was divided between ties and clips. Next, the bronchus was mobilized and this was divided using endo-GIA, again using the purple load. The resection was completed with multiple applications of the endo-GIA with purple load. Additional security of the bronchial closure was accomplished using figure-of-eight suture of 2-0 Vicryl. Nodal sampling was then carried out by incising the pleura posteriorly. Subcarinal space was opened and the level 7 lymph nodes were harvested. Surgicel was placed for hemostasis. The lung was then reflected inferiorly and the level 4 nodes were sampled at this point. Surgicel was again placed. At this point, final irrigation was carried out. There was no bleeding noted. The On-Q pain pump was placed after placement of rib blocks followed by 24 French chest tube. Pericostal sutures were placed through rib holes in the inferior rib and muscles were approximated using 3-0 Vicryl followed by subcuticular 3-0 Vicryl for the skin. This was followed by Steri-Strips, dry sterile dressing, Tegaderm. The patient tolerated the procedure well and was brought back to Recovery Room in stable condition.
I have a couple codes (32484,32505im leaning towards) but I think im wrong can anyone help?
TITLE OF OPERATION: Exploratory thoracotomy with resection of superior segment, right lower lobe and wedge resection, right upper lobe with nodal sampling. An On-Q pain pump was also placed.
DETAILS OF THE PROCEDURE: The patient was brought to the Operating Room and placed in supine position. Following induction of general anesthesia, Foley catheter was placed by nursing staff. He was then placed in left lateral decubitus position on a bean bag with all bony prominences padded. He was prepped and draped in the usual sterile fashion using ChloraPrep. After appropriate time-out, a standard muscle-sparing thoracotomy was carried out through the sixth interspace. Intercostal muscles were divided using Bovie extension. Finochietto retractors were placed, thus giving excellent visualization. The lung deflated nicely with the double lumen tube. Adhesions anteriorly were taken down between the middle lobe and the pericardium. The pulmonary ligament was mobilized and the R9 lymph nodes were sampled. The lower lobe lesion was easily palpable. The upper lobe lesion was somewhat more difficult to palpate. This was wedged out using endo-GIA using the purple loads. The lesion was not easily palpable through the specimen. Accordingly, there was further mobilization of the small pulmonary vein feeding the medial segment of the upper lobe and additional tissue was taken using endo-GIA and passed off the field. Next, the fissure was opened and the pulmonary artery was mobilized. The superior segment of the artery of the lower lobe was mobilized and this was divided between ties and clips. Next, the bronchus was mobilized and this was divided using endo-GIA, again using the purple load. The resection was completed with multiple applications of the endo-GIA with purple load. Additional security of the bronchial closure was accomplished using figure-of-eight suture of 2-0 Vicryl. Nodal sampling was then carried out by incising the pleura posteriorly. Subcarinal space was opened and the level 7 lymph nodes were harvested. Surgicel was placed for hemostasis. The lung was then reflected inferiorly and the level 4 nodes were sampled at this point. Surgicel was again placed. At this point, final irrigation was carried out. There was no bleeding noted. The On-Q pain pump was placed after placement of rib blocks followed by 24 French chest tube. Pericostal sutures were placed through rib holes in the inferior rib and muscles were approximated using 3-0 Vicryl followed by subcuticular 3-0 Vicryl for the skin. This was followed by Steri-Strips, dry sterile dressing, Tegaderm. The patient tolerated the procedure well and was brought back to Recovery Room in stable condition.
I have a couple codes (32484,32505im leaning towards) but I think im wrong can anyone help?