herrera4
Guru
I am very new to coding this and alot of codes are bundled and im not sure what is correct any help is appreciated:
TITLE OF OPERATION: Left-sided thoracentesis followed by right chest thoracoscopy, pleural biopsy, and biopsy of right middle lobe.
The patient was brought to the operating room and placed in the supine position. Following induction of general anesthesia the chest was prepped and draped using ChloraPrep. After infiltration of local anesthetic the chest was entered over the fifth rib in the lateral axillary line. Initially good flow of straw-colored fluid issued forth. The thoracentesis kit catheter was advanced into the pleural space and there was only intermittent flow from the catheter into the evacuated bottle. Total volume was approximately 50 mL. No complications were encountered. The catheter was removed and an occlusive dressing applied. The patient was then placed in the left lateral decubitus position with the right side up. All bony prominences were padded. The patient was secured to the table with both tape and safety strap after flexion and inflation of the bean bag. After executing rib blocks the space was entered through the seventh interspace in the mid axillary line. Thoracoport was inserted as was a suction. Approximately a 1.5 liters of bloody fluid issued forth. The pleural surfaces looked surprisingly clean as did the surface of the lung. Accordingly additional ports were placed anteriorly and using two-handed dissection pleural biopsies were taken. The pleura at the apex was then stripped away using gentle blunt dissection and the pleura which had been elevated was sent for pathology. As noted above, the lung surfaces appeared to be normal. Accordingly a representative wedge biopsy of the middle lobe was taken using three applications of the Endo GIA using the blue duet loads. The specimen was brought out through the initial Thoracoport incision through a small wound protector. Talc was then sprayed in the pleural surface under thoracoscopic control and a 24 French argyle chest tube was brought out through the most inferior of the 5 mm port sites which was in a more lateral position. This was positioned at the apex. The chest tube was secured to the chest wall using heavy silk. Wounds were closed with interrupted sutures of Vicryl for both deep and subcuticular skin closure. Occlusive dressings were applied. Chest tube was placed on suction. The patient was brought back to the Recovery Room in stable condition.
thanks
TITLE OF OPERATION: Left-sided thoracentesis followed by right chest thoracoscopy, pleural biopsy, and biopsy of right middle lobe.
The patient was brought to the operating room and placed in the supine position. Following induction of general anesthesia the chest was prepped and draped using ChloraPrep. After infiltration of local anesthetic the chest was entered over the fifth rib in the lateral axillary line. Initially good flow of straw-colored fluid issued forth. The thoracentesis kit catheter was advanced into the pleural space and there was only intermittent flow from the catheter into the evacuated bottle. Total volume was approximately 50 mL. No complications were encountered. The catheter was removed and an occlusive dressing applied. The patient was then placed in the left lateral decubitus position with the right side up. All bony prominences were padded. The patient was secured to the table with both tape and safety strap after flexion and inflation of the bean bag. After executing rib blocks the space was entered through the seventh interspace in the mid axillary line. Thoracoport was inserted as was a suction. Approximately a 1.5 liters of bloody fluid issued forth. The pleural surfaces looked surprisingly clean as did the surface of the lung. Accordingly additional ports were placed anteriorly and using two-handed dissection pleural biopsies were taken. The pleura at the apex was then stripped away using gentle blunt dissection and the pleura which had been elevated was sent for pathology. As noted above, the lung surfaces appeared to be normal. Accordingly a representative wedge biopsy of the middle lobe was taken using three applications of the Endo GIA using the blue duet loads. The specimen was brought out through the initial Thoracoport incision through a small wound protector. Talc was then sprayed in the pleural surface under thoracoscopic control and a 24 French argyle chest tube was brought out through the most inferior of the 5 mm port sites which was in a more lateral position. This was positioned at the apex. The chest tube was secured to the chest wall using heavy silk. Wounds were closed with interrupted sutures of Vicryl for both deep and subcuticular skin closure. Occlusive dressings were applied. Chest tube was placed on suction. The patient was brought back to the Recovery Room in stable condition.
thanks
