Anna Weaver
Guest
Okay, I need some help here please, would like opinions:
Mr. X is a pleasant 71 year old male who presented to an outside institution for a pneumothorax. He had one chest tube placed and then developed subcutaneous emphysema and a second chest tube placed, again with the developmenet of subcutaneous emphysema and non-resolution of the pneumothorax. He was then transferred to ____. CT scan demonstrated that the chest tube was in the pulmonary parenchyma. The patient was also found to have atrial fibrillation of intermittent type.
Procedure:
The patient was brought to the operating room, administered Ancef, and had sequential compression devices placed. He was placed in the left lateral decubitus position and a lateral thoracotomy was performed in the 6th intercostal space. A section of the 6th rib was removed. On exploring the chest, there were some dense adhesions which were taken down, although some of the adhesions laterally were very difficult to take down and these were left intact. We then were able to see that the chest tube was entered into the right lower lobe. The chest tube was removed and the injury was repaired by performing a wedge excision of the injured segment using an Endo-GIA thick-loaded stapler. We then found that there was still a small air leak and we placed ProGel on the staple line, as well as some additiional pulmonary parenchymal tears. When this was done, we were noted to have a minimal air leak at this point.
We took down the adhesions to the pericardium and there were multiple dense adhesions. We then opened up the pericardium a small amount and found tht the patietn has a Dressler syndrome and dense pericardial adhesions. We decided at that point to abandon the Maze procedure. Three chest tubes were placed. The patient had received a block by the anesthesia service prior to this. We then closed teh thoracotomy incision with 0 vicryl sutures for the pericostal stitches and tehn the serratus muscle was closed with a running vicryl suture. We did not divide the latissimus muscle. We then closed the skin and subcutaneous tissues with multiple layers of running absorbable suture. The patient tolerated the procedure well. There were no immediate complications. All sponge and needle counts were correct. He is in stable, grave condition adn will be transferred to the intensive care unit postoperatively.
We have had two different coders do this
answer #1
998.81, 512.1, 427.31, 423.1 with CPT 32484, 33254-53
answer # 2
512.8, 998.81, 998.2, 411.0, 427.31, 423.1, E879.8, E870.8 with CPT 32110, 32500 with a question of whether should use both, they are not on NCCI, but...
Can I get some opinions please, as you can see, we're not close on the answer?
Mr. X is a pleasant 71 year old male who presented to an outside institution for a pneumothorax. He had one chest tube placed and then developed subcutaneous emphysema and a second chest tube placed, again with the developmenet of subcutaneous emphysema and non-resolution of the pneumothorax. He was then transferred to ____. CT scan demonstrated that the chest tube was in the pulmonary parenchyma. The patient was also found to have atrial fibrillation of intermittent type.
Procedure:
The patient was brought to the operating room, administered Ancef, and had sequential compression devices placed. He was placed in the left lateral decubitus position and a lateral thoracotomy was performed in the 6th intercostal space. A section of the 6th rib was removed. On exploring the chest, there were some dense adhesions which were taken down, although some of the adhesions laterally were very difficult to take down and these were left intact. We then were able to see that the chest tube was entered into the right lower lobe. The chest tube was removed and the injury was repaired by performing a wedge excision of the injured segment using an Endo-GIA thick-loaded stapler. We then found that there was still a small air leak and we placed ProGel on the staple line, as well as some additiional pulmonary parenchymal tears. When this was done, we were noted to have a minimal air leak at this point.
We took down the adhesions to the pericardium and there were multiple dense adhesions. We then opened up the pericardium a small amount and found tht the patietn has a Dressler syndrome and dense pericardial adhesions. We decided at that point to abandon the Maze procedure. Three chest tubes were placed. The patient had received a block by the anesthesia service prior to this. We then closed teh thoracotomy incision with 0 vicryl sutures for the pericostal stitches and tehn the serratus muscle was closed with a running vicryl suture. We did not divide the latissimus muscle. We then closed the skin and subcutaneous tissues with multiple layers of running absorbable suture. The patient tolerated the procedure well. There were no immediate complications. All sponge and needle counts were correct. He is in stable, grave condition adn will be transferred to the intensive care unit postoperatively.
We have had two different coders do this
answer #1
998.81, 512.1, 427.31, 423.1 with CPT 32484, 33254-53
answer # 2
512.8, 998.81, 998.2, 411.0, 427.31, 423.1, E879.8, E870.8 with CPT 32110, 32500 with a question of whether should use both, they are not on NCCI, but...
Can I get some opinions please, as you can see, we're not close on the answer?