tboback
Networker
PROCEDURES PERFORMED:
1. Revision of right ventriculoperitoneal shunt placement.
2. Tandem shunt placement, proximal, no Strata valve shunt, set at 1.0.
3. Shunt placed in tandem more distally, 0.5 setting with anti-siphon
device being placed.
PREOPERATIVE DIAGNOSIS: Hydrocephalus.
POSTOPERATIVE DIAGNOSIS: Hydrocephalus.
ESTIMATED BLOOD LOSS: Less than 20 mL.
INDICATIONS: The patient is a 75-year-old male who was evaluated in the
clinic secondary to his issues of hydrocephalus as well as recurrent
subdural hematoma on the right side seems at his previous shunt placement.
After successfully resolved, we discussed the risks and benefits of
placing a tandem reservoirs, and the patient was agreeable and did elect
to undergo surgical intervention. All risks and benefits were explained
to him, he was agreeable.
DESCRIPTION OF PROCEDURE: The patient was brought to the operative suite,
where he was placed under general anesthesia in supine position with all
pressure points being padded appropriately. His shoulder roll was placed
behind his right shoulder, turning his right to the head was supported
appropriately. After the area of surgery on the right side was shaved,
the patient was prepped and draped in the usual sterile fashion. Once
this was completed, the skin was infiltrated with 0.25% Marcaine with
epinephrine. Utilizing a #10 blade, the skin incision was made. The area
underneath the flap was released utilizing electrocautery Bovie.
Self-retaining Weitlaner was placed within it. The previous reservoir was
removed, and approximately, we did verify that the flow was still flowing
to the ventricular catheter and _____ was set at 1.0 was attached to it.
More distally, the catheter was identified. The tissue was released and
another valve was actually attached and set at 0.5 with an anti-siphon
device. All areas of connection between them were then tied utilizing 2-0
silk Vicryl suture. The shunt itself was actually secured to some scar
tissue underneath utilizing 4-0 Vicryl suture. Once this was completed,
attention was given to the burr hole. The burr hole cover was placed ____
to fit for the ventricular catheter. Once this was secured, the area was
irrigated with antibiotic solution. The galea was approximated utilizing
2-0 popoff Vicryl suture with an intervening 3-0 popoff Vicryl suture.
Staples were placed at the skin. The patient tolerated the procedure
well. All counts correct and he will be observed overnight. A
postoperative CT scan of the brain has been ordered.
I spoke to the surgeon to confirm, yes revision of old shunt and a second shunt was placed in tandem both on the right side.
Would 62230 AND 62223 be appropriate for this?
1. Revision of right ventriculoperitoneal shunt placement.
2. Tandem shunt placement, proximal, no Strata valve shunt, set at 1.0.
3. Shunt placed in tandem more distally, 0.5 setting with anti-siphon
device being placed.
PREOPERATIVE DIAGNOSIS: Hydrocephalus.
POSTOPERATIVE DIAGNOSIS: Hydrocephalus.
ESTIMATED BLOOD LOSS: Less than 20 mL.
INDICATIONS: The patient is a 75-year-old male who was evaluated in the
clinic secondary to his issues of hydrocephalus as well as recurrent
subdural hematoma on the right side seems at his previous shunt placement.
After successfully resolved, we discussed the risks and benefits of
placing a tandem reservoirs, and the patient was agreeable and did elect
to undergo surgical intervention. All risks and benefits were explained
to him, he was agreeable.
DESCRIPTION OF PROCEDURE: The patient was brought to the operative suite,
where he was placed under general anesthesia in supine position with all
pressure points being padded appropriately. His shoulder roll was placed
behind his right shoulder, turning his right to the head was supported
appropriately. After the area of surgery on the right side was shaved,
the patient was prepped and draped in the usual sterile fashion. Once
this was completed, the skin was infiltrated with 0.25% Marcaine with
epinephrine. Utilizing a #10 blade, the skin incision was made. The area
underneath the flap was released utilizing electrocautery Bovie.
Self-retaining Weitlaner was placed within it. The previous reservoir was
removed, and approximately, we did verify that the flow was still flowing
to the ventricular catheter and _____ was set at 1.0 was attached to it.
More distally, the catheter was identified. The tissue was released and
another valve was actually attached and set at 0.5 with an anti-siphon
device. All areas of connection between them were then tied utilizing 2-0
silk Vicryl suture. The shunt itself was actually secured to some scar
tissue underneath utilizing 4-0 Vicryl suture. Once this was completed,
attention was given to the burr hole. The burr hole cover was placed ____
to fit for the ventricular catheter. Once this was secured, the area was
irrigated with antibiotic solution. The galea was approximated utilizing
2-0 popoff Vicryl suture with an intervening 3-0 popoff Vicryl suture.
Staples were placed at the skin. The patient tolerated the procedure
well. All counts correct and he will be observed overnight. A
postoperative CT scan of the brain has been ordered.
I spoke to the surgeon to confirm, yes revision of old shunt and a second shunt was placed in tandem both on the right side.
Would 62230 AND 62223 be appropriate for this?