codedog
True Blue
i am confused on which way to code it came back as mETASTATIC HIGH GRADE POORLY DIFFERENTIATED ADENOCARCINOMA (SEE COMMENT). 49250 , ? or 116xx , thanks
PREOPERATIVE DIAGNOSES:1. Peri-umbilical Chronic Wound.
OPERATION: Excision of Peri-umbilical Chronic Wound (3 cm)
DESCRIPTION OF OPERATIVE PROCEDURE: Once informed consents were obtained, patient was taken to the operating room, placed supine on the operating table. After general endotracheal anesthesia was induced, the abdomen was prepped and draped in the standard surgical fashion. Periumbilical incision was made with a scalpel, upon which the dissection was carried out to the level of the anterior rectus fascia. The entire chronic wound was excised including surrounding tissues. There was a umbilical defect which was approximately 2 cm in greatest dimension. This was then closed with a 0 Ethibond suture in a figure-of-eight fashion x2. The wound was then irrigated and dried with no active bleeding noted. The umbilical stalk was then reapproximated to the abdominal fascia with 3-0 Vicryl suture. The skin was then closed in 2 layer fashion with 3-0 Vicryl followed by 4-0 Vicryl suture in running subcuticular fashion. kin was cleaned and dried, and a dry sterile pressure dressing was then placed in the wound.
PREOPERATIVE DIAGNOSES:1. Peri-umbilical Chronic Wound.
OPERATION: Excision of Peri-umbilical Chronic Wound (3 cm)
DESCRIPTION OF OPERATIVE PROCEDURE: Once informed consents were obtained, patient was taken to the operating room, placed supine on the operating table. After general endotracheal anesthesia was induced, the abdomen was prepped and draped in the standard surgical fashion. Periumbilical incision was made with a scalpel, upon which the dissection was carried out to the level of the anterior rectus fascia. The entire chronic wound was excised including surrounding tissues. There was a umbilical defect which was approximately 2 cm in greatest dimension. This was then closed with a 0 Ethibond suture in a figure-of-eight fashion x2. The wound was then irrigated and dried with no active bleeding noted. The umbilical stalk was then reapproximated to the abdominal fascia with 3-0 Vicryl suture. The skin was then closed in 2 layer fashion with 3-0 Vicryl followed by 4-0 Vicryl suture in running subcuticular fashion. kin was cleaned and dried, and a dry sterile pressure dressing was then placed in the wound.