Wiki mediastinal explor vs sternal debridement

[aguelfi]

I have a patient who had a aortic dissection repair in the morning. The pt's BD dropped in the ICU and the surgeon reopened is chest at the bedside got him stable and returned him to th OR. In the OR the doctor explored his chest, cauterized some oozing on the chest wall, opened bilateral pleural cavities adn inserted chest tubes. Then closed his chest again.
Because the chest wasn't opened in the OR I don't think a medialstinal exporation, 39010 is appropriate. And I don't think 21750 is correct either because the chest didn't separate on it's own (dehisence), it was opened by the physician. So I'm looking at just sternal debridement 21627. Any thoughts?

 

[Brooke8565]

I agree, I would use 21627

 

[lisigirl]

No, you should be billing 35820 - exploration for postop hemorrhage, thrombosis or infection; chest. This covers the exploration, debridement and repair.

Lisi, CPC
eharkler@nmh.org

 

[aguelfi]

But he didn't open it in the OR. He opened it at the bedside to administer inotropic.

 

[FTessaBartels]

He DID explore the chest

CT is NOT my area of expertise, but ...

Regardless of where he opened the chest, the surgeon DID explore the chest in the OR. I would code 35820.

F Tessa Bartels, CPC, CEMC

 

[Michelle Thompson]

I agree with 35820 with modifier 78.

 

[aguelfi]

Thanks to all.