Can i get CPT help please 31603, 31605, 31610 ????????
DESCRIPTION OF PROCEDURE: patient was placed into a modified beach-chair position with neck hyperextension. The neck and superior chest was then prepped and draped in standard fashion. Incision was made approximately 2 fingerbreadths above the sternal notch, and a skinfold was carried through the subcutaneous tissue down to the platysma, which was then divided with electrocautery. The strap muscles were then divided in the midline, and the thyroid was then immediately identified below. Of note, the patient had a generous thyroid isthmus that appeared to require division. The strap muscles were then elevated and mobilized out of the way. The isthmus was divided using electrocautery. Hemostasis was maintained with suture ligatures to the small delicate vessels and electrocautery. The trachea was then identified and exposed. The cricoid cartilage was grasped and elevated superiorly. The tracheal rings were identified and counted. Anchoring sutures were then placed on either side of the second and third tracheal rings, which were then used to mobilize the trachea cephalad. After coordination with anesthesia to minimize the oxygen content and gain control of the general endotracheal tube. The #8 Shiley tracheostomy tube was tested at the balloon and lubricated and once these preparations were made, a transverse incision was then made in the trachea in between the third and fourth tracheal ring. The endotracheal tube was identified, and a tracheal dilator was then placed to dilate the opening. After coordinating with anesthesia, the oral endotracheal tube was gradually withdrawn under direct vision, and the tracheostomy tube was then entered into the trachea. The anchoring sutures were fixated to the device, and the tube was recannulated and connected to the ventilator. Good positioning was verified by capnography. The wound was then examined, and meticulous hemostasis was obtained. The strap muscles were then reapproximated around the stoma using 3-0 Vicryl in an interrupted fashion. The subcutaneous tissues were then reapproximated using 2-0 Vicryl in an interrupted fashion. The stoma appliance was sutured to the skin using 3-0 nylon. Dressings were then applied. The patient was then able to be brought to the ICU.
DESCRIPTION OF PROCEDURE: patient was placed into a modified beach-chair position with neck hyperextension. The neck and superior chest was then prepped and draped in standard fashion. Incision was made approximately 2 fingerbreadths above the sternal notch, and a skinfold was carried through the subcutaneous tissue down to the platysma, which was then divided with electrocautery. The strap muscles were then divided in the midline, and the thyroid was then immediately identified below. Of note, the patient had a generous thyroid isthmus that appeared to require division. The strap muscles were then elevated and mobilized out of the way. The isthmus was divided using electrocautery. Hemostasis was maintained with suture ligatures to the small delicate vessels and electrocautery. The trachea was then identified and exposed. The cricoid cartilage was grasped and elevated superiorly. The tracheal rings were identified and counted. Anchoring sutures were then placed on either side of the second and third tracheal rings, which were then used to mobilize the trachea cephalad. After coordination with anesthesia to minimize the oxygen content and gain control of the general endotracheal tube. The #8 Shiley tracheostomy tube was tested at the balloon and lubricated and once these preparations were made, a transverse incision was then made in the trachea in between the third and fourth tracheal ring. The endotracheal tube was identified, and a tracheal dilator was then placed to dilate the opening. After coordinating with anesthesia, the oral endotracheal tube was gradually withdrawn under direct vision, and the tracheostomy tube was then entered into the trachea. The anchoring sutures were fixated to the device, and the tube was recannulated and connected to the ventilator. Good positioning was verified by capnography. The wound was then examined, and meticulous hemostasis was obtained. The strap muscles were then reapproximated around the stoma using 3-0 Vicryl in an interrupted fashion. The subcutaneous tissues were then reapproximated using 2-0 Vicryl in an interrupted fashion. The stoma appliance was sutured to the skin using 3-0 nylon. Dressings were then applied. The patient was then able to be brought to the ICU.
