toiwalker
Networker
Can some one please hepl me with this? I coded 61315 and 88307. Is duraplasty included in the code?
PROCEDURE:
1. Suboccipital craniectomy.
2. Evacuation of cerebellar hematoma.
3. Left cerebellar hemispherectomy.
4. Duraplasty.
OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS:
Left cerebellar intraparenchymal hematoma with herniation.
POSTOPERATIVE DIAGNOSIS:
Left cerebellar intraparenchymal hematoma with herniation.
DETAILS OF THE PROCEDURE:
Informed consent for the procedure was obtained from the patient's husband by Dr. Saphier. Relevant risks and complications were discussed include the risk of infection, stroke, scar, need for reoperation, neurological deficits, meningitis, cerebrospinal fluid leak, coma, paralysis, death. The patient taken to the operating room, intubated in a critical condition. Prior to commencement of the procedure, timeout was performed to verify the site and side of procedure as well as the patient's identification. General endotracheal tube anesthesia was administered by the
anesthesiology attending who also monitored the patient throughout the entire case. The patient was placed in 3-point pin fixation in the Mayfield head holder and subsequently turned to the prone position on holsters with the head flexed. Care was taken to ensure adequate padding of all pressure points. The patient's suboccipital region and posterior neck and
chest were shaved, prepped and draped in standard and sterile manner. Lidocaine 1% was infused in the region of planned incision. The #10 scalpel blade was utilized to create a linear incision and self-retaining retractors were placed within the field. Hemostasis was obtained with a combination of bipolar and Bovie cautery. Incision was continued through the dorsal midline fascial raphae and an avascular plane was created in the median raphae. Subperiosteal dissection was performed in the suboccipital region and both Cl and C2 were identified. Subperiosteal plane was created from C1. Copious irrigation was applied. After the suboccipital region was completely exposed and the margins of the foramen magnum were identified, the M2 drill bit and Stryker drill were utilized to create a suboccipital craniectomy. Combination ofLeksell and Kerrison rongeurs were utilized to complete the craniectomy, and the foramen magnum was subsequently removed. After completion of suboccipital craniectomy, a #15 blade was utilized was used to create durotomy in tlte left cerebellar dura. Immediately upon creation of durotomy, herniation of the cerebellum was encountered. Bipolar cautery was utilized to create a corticotomy, and immediately upon corticotomy, a large acute hematoma was expressed. After adequate evacuation of the hematoma, a left cerebellar hemispherectomy was performed. Specimen of the hematoma was sent for patltological analysis. After the cerebellar hemispherectomy and evacuation of the entire hematoma, the cerebellum was noted to be significantly more relaxed. Copious irrigation was applied and hemostasis was obtained. Surgicel was placed within the surgical bed. Next, a piece of Duragen was laid over the corticotomy and DuraSeal was applied. Next, the incision was subsequently approximated in layers utilizing 0 Vicryl suture for the deep layers and 3-0 Vicryl suture for the subcutaneous plane. Staples were used for skin approximation. The incision was thoroughly washed and dried and a sterile dressing was applied. The patient was subsequently returned to the supine position and the Mayfield head holder was removed. Tbe patient was subsequently transferred to the neurosurgical intensive care unit, intubated, in critical condition.
PROCEDURE:
1. Suboccipital craniectomy.
2. Evacuation of cerebellar hematoma.
3. Left cerebellar hemispherectomy.
4. Duraplasty.
OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS:
Left cerebellar intraparenchymal hematoma with herniation.
POSTOPERATIVE DIAGNOSIS:
Left cerebellar intraparenchymal hematoma with herniation.
DETAILS OF THE PROCEDURE:
Informed consent for the procedure was obtained from the patient's husband by Dr. Saphier. Relevant risks and complications were discussed include the risk of infection, stroke, scar, need for reoperation, neurological deficits, meningitis, cerebrospinal fluid leak, coma, paralysis, death. The patient taken to the operating room, intubated in a critical condition. Prior to commencement of the procedure, timeout was performed to verify the site and side of procedure as well as the patient's identification. General endotracheal tube anesthesia was administered by the
anesthesiology attending who also monitored the patient throughout the entire case. The patient was placed in 3-point pin fixation in the Mayfield head holder and subsequently turned to the prone position on holsters with the head flexed. Care was taken to ensure adequate padding of all pressure points. The patient's suboccipital region and posterior neck and
chest were shaved, prepped and draped in standard and sterile manner. Lidocaine 1% was infused in the region of planned incision. The #10 scalpel blade was utilized to create a linear incision and self-retaining retractors were placed within the field. Hemostasis was obtained with a combination of bipolar and Bovie cautery. Incision was continued through the dorsal midline fascial raphae and an avascular plane was created in the median raphae. Subperiosteal dissection was performed in the suboccipital region and both Cl and C2 were identified. Subperiosteal plane was created from C1. Copious irrigation was applied. After the suboccipital region was completely exposed and the margins of the foramen magnum were identified, the M2 drill bit and Stryker drill were utilized to create a suboccipital craniectomy. Combination ofLeksell and Kerrison rongeurs were utilized to complete the craniectomy, and the foramen magnum was subsequently removed. After completion of suboccipital craniectomy, a #15 blade was utilized was used to create durotomy in tlte left cerebellar dura. Immediately upon creation of durotomy, herniation of the cerebellum was encountered. Bipolar cautery was utilized to create a corticotomy, and immediately upon corticotomy, a large acute hematoma was expressed. After adequate evacuation of the hematoma, a left cerebellar hemispherectomy was performed. Specimen of the hematoma was sent for patltological analysis. After the cerebellar hemispherectomy and evacuation of the entire hematoma, the cerebellum was noted to be significantly more relaxed. Copious irrigation was applied and hemostasis was obtained. Surgicel was placed within the surgical bed. Next, a piece of Duragen was laid over the corticotomy and DuraSeal was applied. Next, the incision was subsequently approximated in layers utilizing 0 Vicryl suture for the deep layers and 3-0 Vicryl suture for the subcutaneous plane. Staples were used for skin approximation. The incision was thoroughly washed and dried and a sterile dressing was applied. The patient was subsequently returned to the supine position and the Mayfield head holder was removed. Tbe patient was subsequently transferred to the neurosurgical intensive care unit, intubated, in critical condition.