Unlisted procedure. Please help, need a 2nd opinion for CV surgery

deeva456

Expert
Messages
285
Location
Sacramento, CA
Best answers
0
I So far I have come up with 32100-52 but not sure about the rest. Use an unlisted code?
Thank you

PRE-PROCEDURE DIAGNOSIS:
Long-standing persistent atrial fibrillation, at risk of embolic stoke
Gastrointestinal bleeding
Inability to take anticoagulation medication
NYHA Functional Class Highest within past 2 weeks from OR date: Class I: Patient has cardiac disease but without resulting limitations of ordinary physical activity. Ordinary physical activity (e.g., walking several blocks or climbing stairs) does not cause undue fatigue, palpitation, dyspnea, or anginal pain. Limiting symptoms may occur with marked exertion.
PROCEDURE(S) PERFORMED: Procedure(s):

ATTEMPTED LEFT VIDEO ASSISTED THORACOSCOPY, LEFT THORACOTOMY FOR ATTEMPTED LEFT ATRIAL CLIP
TRANSESOPHAGEAL ECHOCARDIOGRAPHY
Lysis of adhesions
Heart Failure Present : No
FINDINGS:
1) Left lung densely adherent to anterior chest wall, making it impossible to safely retract the lung posterolaterally to access the left hilum and left atrial appendage.
2)  Pericardium adhered to heart
3)  Thorascopic attempt converted to open to try to complete procedure.  Even open thoracotomy proved to be too unsafe to proceed.
IMPLANTS/DEVICES:
* No implants in log *


SPECIMENS:
 None
COMPLICATIONS: none
ESTIMATED BLOOD LOSS:  100mL
DRAINS: 1 24 Fr Spiral drain
Description of Procedure:
The patient was brought into the OR and placed in a supine position. Anesthesiology placed the invasive monitoring line and TEE probe. The left atrial appendage was evaluated and found to have NO thrombus within the left atrial appendage.  The patient was prepped and draped in the usual sterile fashion.
A 5 mm trocar was used with a 0 degree scope to enter the left chest.  Anesthesia was asked to deflate the left lung.  A 30 degree scope was then used to place a 12 mm trocar and 2 additional 5 mm trocars laterally to the left.
The left lung was found to be markedly adherent to the anterior chest wall.  After 30 minutes of working to obtain the appropriate exposure, it became apparent that a minimally invasive technique would not work.  I decided to convert to anterolateral thoracotomy.  While exposure was better, I still was not able to safely take the lung down from the anterior left chest wall.  The pericardium also was densely adherent to the heart, again, making it unsafe to proceed.  I decided to back out to prevent any complications.  The chest was irrigated with warm saline, peri costal sutures were placed.  The muscle layers were closed with #1 vicryl in a running fashion.  The fat, subcutaneous tissus and skin were all closed in a serials fashion.  We then placed a 24Fr spiral drain, inflated the left lung, removed all trocars and closed the skin.

DISPOSITION: PACU
CONDITION: Stable
 
Top