Agrant77
New
Am I able to code 19303-RT, 38525, 38900, and 11042, & 11045? Any suggestions?
PROCEDURE IN DETAIL:
After consent was obtained, the patient was transferred from
preop holding area to the operating suite. The patient placed
in supine position on the operating table. Appropriate
cardiopulmonary monitors were then attached. The patient was
then induced under general anesthesia. The patient was
identified, time-out called, procedure and site of procedure confirmed.
Inspection and palpation of the right breast noted palpable firm mass lower inner quadrant. Purple skin marking noted in the right axilla from lymphoscintigraphy. Lymphoscintigraphy images were again reviewed. Patient was prepped and draped in normal sterile fashion. 5 mL of Lymphazurin blue dye was then injected into the right nipple aereolar complex. Breast was massaged for greater than 5 minutes. Skin marking pen was then used to mark out an ellipse surrounding the nipple areolar complex. 10 blade was then used to make a skin incision on the lateral portion of the ellipse. Further dissection was carried out with Bovie electrocautery. Hemostasis checked and achieved. Dissection was carried out into the axilla. Neoprobe was then used to help identify hot lymph node which was also blue. This was dissected free and removed from the patient. 10 second count was 31,988. Specimen was passed off and sent for permanent pathology. Neoprobe was again used within the axilla. However there were no other areas of hot activity noted. Skin was then further incised with 10 blade. Starting at the superior flap, this was dissected free with Bovie electrocautery. Flap was carried out to the clavicle. Dissection was carried out down to the pectoralis. Pectoralis fascia was dissected and included in the specimen. In similar fashion inferior flap was created dissection was carried out to the inframammary fold. Dissection carried out down to the pectoralis. Pectoralis fascia was dissected free and included in the specimen. Specimen was then swept laterally to the tail of the breast which was included in the specimen. This completed the right mastectomy. Specimen was then tagged with silk suture: short superior, long lateral, and double deep. Wound was irrigated with copious amounts of warm saline solution. Irrigant ran clear and was suction from the patient. The inferior skin flap overlying the area of previous tumor was quite thin and had to be excised full-thickness skin with a 10 blade. Size of excision was 12 cm in length by 3 cm in width (36 cm²). Given its close proximity to the tumor this was also tagged short superior long lateral and double deep. Specimen was passed off and sent for pathology. Hemostasis checked and achieved in the wound bed. 10 flat JP drain was then placed in the axilla and brought out through separate stab incision. JP drain was then sewn to the skin with 3-0 nylon in interrupted fashion and placed to bulb suction. Skin was then closed in the deep dermal layers with 3-0 Vicryl in multiple interrupted fashion. Skin was then closed further with 4-0 Monocryl in running subcuticular fashion. Wound was washed dried and Dermabond dressing placed. After the Dermabond had dried 4 x 4's Kerlix and an Ace wrap placed. Physician's assistant was used for retraction and exposure to allow for appropriate dissection and identification of vital structures. He was also used to help close skin. The patient tolerated the procedure well. The patient was allowed to awaken out of general anesthesia. The patient was then transferred from operating suite to the postanesthesia care unit in stable condition. All counts were correct x2.
PROCEDURE IN DETAIL:
After consent was obtained, the patient was transferred from
preop holding area to the operating suite. The patient placed
in supine position on the operating table. Appropriate
cardiopulmonary monitors were then attached. The patient was
then induced under general anesthesia. The patient was
identified, time-out called, procedure and site of procedure confirmed.
Inspection and palpation of the right breast noted palpable firm mass lower inner quadrant. Purple skin marking noted in the right axilla from lymphoscintigraphy. Lymphoscintigraphy images were again reviewed. Patient was prepped and draped in normal sterile fashion. 5 mL of Lymphazurin blue dye was then injected into the right nipple aereolar complex. Breast was massaged for greater than 5 minutes. Skin marking pen was then used to mark out an ellipse surrounding the nipple areolar complex. 10 blade was then used to make a skin incision on the lateral portion of the ellipse. Further dissection was carried out with Bovie electrocautery. Hemostasis checked and achieved. Dissection was carried out into the axilla. Neoprobe was then used to help identify hot lymph node which was also blue. This was dissected free and removed from the patient. 10 second count was 31,988. Specimen was passed off and sent for permanent pathology. Neoprobe was again used within the axilla. However there were no other areas of hot activity noted. Skin was then further incised with 10 blade. Starting at the superior flap, this was dissected free with Bovie electrocautery. Flap was carried out to the clavicle. Dissection was carried out down to the pectoralis. Pectoralis fascia was dissected and included in the specimen. In similar fashion inferior flap was created dissection was carried out to the inframammary fold. Dissection carried out down to the pectoralis. Pectoralis fascia was dissected free and included in the specimen. Specimen was then swept laterally to the tail of the breast which was included in the specimen. This completed the right mastectomy. Specimen was then tagged with silk suture: short superior, long lateral, and double deep. Wound was irrigated with copious amounts of warm saline solution. Irrigant ran clear and was suction from the patient. The inferior skin flap overlying the area of previous tumor was quite thin and had to be excised full-thickness skin with a 10 blade. Size of excision was 12 cm in length by 3 cm in width (36 cm²). Given its close proximity to the tumor this was also tagged short superior long lateral and double deep. Specimen was passed off and sent for pathology. Hemostasis checked and achieved in the wound bed. 10 flat JP drain was then placed in the axilla and brought out through separate stab incision. JP drain was then sewn to the skin with 3-0 nylon in interrupted fashion and placed to bulb suction. Skin was then closed in the deep dermal layers with 3-0 Vicryl in multiple interrupted fashion. Skin was then closed further with 4-0 Monocryl in running subcuticular fashion. Wound was washed dried and Dermabond dressing placed. After the Dermabond had dried 4 x 4's Kerlix and an Ace wrap placed. Physician's assistant was used for retraction and exposure to allow for appropriate dissection and identification of vital structures. He was also used to help close skin. The patient tolerated the procedure well. The patient was allowed to awaken out of general anesthesia. The patient was then transferred from operating suite to the postanesthesia care unit in stable condition. All counts were correct x2.