Mrsrpc
Guru
"PREOPERATIVE DIAGNOSIS: Anterior mediastinal mass. POSTOPERATIVE DIAGNOSIS: Anterior mediastinal mass |1|. PROCEDURE PERFORMED: Removal of anterior mediastinal mass by median sternotomy |2|. PLACE OF SERVICE: Hospital. INDICATIONS FOR PROCEDURE: The patient is a 66-year-old, white female who on CAT scan is noted to have anterior mediastinal mass |3|. The patient is taken at this time for surgical resection. INTRAOPERATIVE FINDINGS: Mass in the thymic tissue at the level of the innominate vein. The mass appeared to be thyroid tissue, however, there was no connection with the thyroid gland itself. DESCRIPTION OF PROCEDURE: The patient is taken to the operating room after adequate general endotracheal anesthesia and prophylactic antibiotics. The patient was prepped and draped in the usual sterile fashion. The chest was entered through a standard median sternotomy |4|. The thymic fat was removed from the top of the pericardium up to the innominate vein and the top of the thymic fat. The mass was dissected off the innominate vein and off the left subclavian vein. There were no attachments in the neck. The blood supply was coming in low lateral on the right off of the internal mammary artery. These branches were clipped and divided. The mass was removed on block and sent to pathology. The mass appears to be thyroid tissue, however, is not attached to the thyroid. The blood supply is coming off the right mammary. Following this the area was irrigated; hemostasis was completed. The chest tube was placed into the mediastinum |5|. The sternum was then closed with stainless steel wires. Most of the subcutaneous tissue was closed with running Vicryl subcuticular. 3-0 Vicryl was used to close the skin. Dermabond was applied and dry sterile dressing was applied. The patient received no blood or blood products and returned to recovery in good condition." ICD 10 R22.2 is the answer, but the 2023 ICD 10 code book describes R22 as Swelling, Lump or Mass of Skin and Subcutaneous tissue, with R22.2 being of the trunk. This is clearly not of the skin or SQ tissue; it's lined with connective tissue. I would have coded Disease of Mediastinum NEC. How can I not make this mistake again. I can very seriously argue why the book's answer is incorrect, given the different types of tissue involved. that's just basic A & P. Again, i don't think i can ever see things the way AAPC does