I need any & all input on the following scenario:
PROCEDURE: Stereotactic palcement of extraventricular catheter, left frontal, neural endoscopy.
OPERATIVE DETAILS:
Informed consent was obtained in the preoperative area. The patient was brought back to the operating room. Monitoring equipment was placed by anesthesia. The patient was intubated. The endotracheal tube was securely in place. The patient's head was placed in a Mayfield head holder and connected to the operating room table. The patient's head was then calibrated with the Stealth equipment. An appropriate trajectory was determined using Stealth equipment. A small amount of hair was shaved. A marking pen was used to mark the incision. The patient was then prepped and draped in sterile fashion. No local anesthetic was used due to several previous surgeries. A 10-0 skin blade knife was used to make the initial incision. Hemostasis & soft tissue dissection was done with the monopolar cautery down. A high-speed drill was used to make a bur hole. Using the Stealth-guided equipment, an appropriate trajectory into the left frontal horn was determined. A peel-away sheath was then placed by Stealth guidance into the left frontal horn. A neuro endoscope was then placed inside the sheath. The ventricular anatomy was well visualized. There had been a previous septostomy that had been placed that was well observed. The septostomy appeared open. There appeared to be good flow through the septostomy as well as through the foramen of Monro, which could be seen. The foramen of Monro was, however, narrow. I assume that this has been present for some time. Once adequate visualization of the ventricular anatomy was completed, the endoscope was removed. A proximal catheter was then placed through the peel-away sheath into the left frontal horn. There was good CSF drainage through the catheter. The sheath was then removed. The extraventricular drain was then tunneled up underneath the skin. The area was irrigated with copious amounts of saline. A bur hole cover to accommodate a catheter was then placed. The was screwed into place. The galea was closed with 2-0 Vicryl stitches. The skin was stapled closed. The extraventricular drain was clamped until it could be directly connected to the Becker drainage system. Antibiotic ointment was placed over the staples. The drapes were then removed. Once anesthesia felt it was safe, the endotrachial tube was removed. The patient's Mayfield head holder was removed without difficulty. The patient tolerated the procedure well. The patient was then transferred to recovery in stable condition. The patient was moving all extremities well.
I feel like I'm either missing something or overthinking this but I have coded it this way:
61210 - Burr hole; for implanting ventricular catheter, reservoir, EEG electrode(s), pressure recording device, or other cerebral monitoring device
62160 - Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage
61781 - Stereotactic computer assisted (navigational) procedure;cranial intradural
Thanks in advance!
Tammy
PROCEDURE: Stereotactic palcement of extraventricular catheter, left frontal, neural endoscopy.
OPERATIVE DETAILS:
Informed consent was obtained in the preoperative area. The patient was brought back to the operating room. Monitoring equipment was placed by anesthesia. The patient was intubated. The endotracheal tube was securely in place. The patient's head was placed in a Mayfield head holder and connected to the operating room table. The patient's head was then calibrated with the Stealth equipment. An appropriate trajectory was determined using Stealth equipment. A small amount of hair was shaved. A marking pen was used to mark the incision. The patient was then prepped and draped in sterile fashion. No local anesthetic was used due to several previous surgeries. A 10-0 skin blade knife was used to make the initial incision. Hemostasis & soft tissue dissection was done with the monopolar cautery down. A high-speed drill was used to make a bur hole. Using the Stealth-guided equipment, an appropriate trajectory into the left frontal horn was determined. A peel-away sheath was then placed by Stealth guidance into the left frontal horn. A neuro endoscope was then placed inside the sheath. The ventricular anatomy was well visualized. There had been a previous septostomy that had been placed that was well observed. The septostomy appeared open. There appeared to be good flow through the septostomy as well as through the foramen of Monro, which could be seen. The foramen of Monro was, however, narrow. I assume that this has been present for some time. Once adequate visualization of the ventricular anatomy was completed, the endoscope was removed. A proximal catheter was then placed through the peel-away sheath into the left frontal horn. There was good CSF drainage through the catheter. The sheath was then removed. The extraventricular drain was then tunneled up underneath the skin. The area was irrigated with copious amounts of saline. A bur hole cover to accommodate a catheter was then placed. The was screwed into place. The galea was closed with 2-0 Vicryl stitches. The skin was stapled closed. The extraventricular drain was clamped until it could be directly connected to the Becker drainage system. Antibiotic ointment was placed over the staples. The drapes were then removed. Once anesthesia felt it was safe, the endotrachial tube was removed. The patient's Mayfield head holder was removed without difficulty. The patient tolerated the procedure well. The patient was then transferred to recovery in stable condition. The patient was moving all extremities well.
I feel like I'm either missing something or overthinking this but I have coded it this way:
61210 - Burr hole; for implanting ventricular catheter, reservoir, EEG electrode(s), pressure recording device, or other cerebral monitoring device
62160 - Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage
61781 - Stereotactic computer assisted (navigational) procedure;cranial intradural
Thanks in advance!
Tammy