I need help coding CPT's for the following procedure:
POSTOPERATIVE DIAGNOSIS:
Sternal infection, implantable cardioverter defibrillator implant infection.
OPERATION PERFORMED:
Incision and drainage of sternomanubrial junction in open fashion with debridement of the joint capsule and Pulsavac irrigation as well as placement of a sterile VAC system.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room and administered general
anesthesia. After sterile prep and drape, an incision was made from 2
fingerbreadths below the sternal notch to just over the manubrial and sternal
junction for a total length of 6 cm, carried through subcutaneous tissue using
electrocautery. The sternomanubrial area was identified. The sternum was felt fairly solid. On further dissection both laterally, the joint between the
sternum and the manubrium, as well as the left costal cartilage was identified
to be somewhat ballottable. A needle was placed into the joint space and fluid was sent for culture and Gram stain. It appeared somewhat cloudy in nature. Subsequently, this was opened and the area was debrided. The bone was quite fragile and appeared to be destroyed. Rongeur was utilized to curet this area as was the lateral aspect where the cartilage was. Subsequently a space was created between the sternum and the manubrium. Anterior table of the sternum was removed and the posterior sternal table appeared to be intact, or at least a fibrous portion of it. The space was roughly 2 x 1 cm wide with a small trough that went laterally by the costocartilage joint. Would was the Pulsavac'd and irrigated. Consultation and within an orthopod in regards to infected joints was obtained and it was elected to place a 15-French drain into the space, primarily for irrigation. This was tunneled through a separate stab wound and brought out through the lateral aspect of the chest. Subsequently, the wounds were then dressed with a VAC and the muscle overlying the VAC was reapproximated with Vicryl sutures in an interrupted fashion, and subsequently a running suture was utilized to close the skin with the VAC and the nipple of the VAC exposed
for drainage.
POSTOPERATIVE DIAGNOSIS:
Sternal infection, implantable cardioverter defibrillator implant infection.
OPERATION PERFORMED:
Incision and drainage of sternomanubrial junction in open fashion with debridement of the joint capsule and Pulsavac irrigation as well as placement of a sterile VAC system.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room and administered general
anesthesia. After sterile prep and drape, an incision was made from 2
fingerbreadths below the sternal notch to just over the manubrial and sternal
junction for a total length of 6 cm, carried through subcutaneous tissue using
electrocautery. The sternomanubrial area was identified. The sternum was felt fairly solid. On further dissection both laterally, the joint between the
sternum and the manubrium, as well as the left costal cartilage was identified
to be somewhat ballottable. A needle was placed into the joint space and fluid was sent for culture and Gram stain. It appeared somewhat cloudy in nature. Subsequently, this was opened and the area was debrided. The bone was quite fragile and appeared to be destroyed. Rongeur was utilized to curet this area as was the lateral aspect where the cartilage was. Subsequently a space was created between the sternum and the manubrium. Anterior table of the sternum was removed and the posterior sternal table appeared to be intact, or at least a fibrous portion of it. The space was roughly 2 x 1 cm wide with a small trough that went laterally by the costocartilage joint. Would was the Pulsavac'd and irrigated. Consultation and within an orthopod in regards to infected joints was obtained and it was elected to place a 15-French drain into the space, primarily for irrigation. This was tunneled through a separate stab wound and brought out through the lateral aspect of the chest. Subsequently, the wounds were then dressed with a VAC and the muscle overlying the VAC was reapproximated with Vicryl sutures in an interrupted fashion, and subsequently a running suture was utilized to close the skin with the VAC and the nipple of the VAC exposed
for drainage.