MelBarclay
Guest
Procedure Performed: Right VATs surgery with right apical lung resection and chest tube placement for mechanical pleurodesis.
OPERATIVE COURSE: Patient was taken to the operating room, timeout called, everyone agreed, anesthesia provided. Patient positioned and padded in the left lateral decubitus position with right side up. The old chest tube was removed and the patient was given antibiotics. The trocars placed without issue under direct visualization and the camera placed as well. Multiple apical blebs were identified, photographed. These were 3-4 cm in size greater than 5-6 in nature and in the apex. There were some adhesions and these had to be taken down with laparoscopic scissors and small Hemoclips without any significant bleeding whatsoever. I then placed an Echelon 60 white load vascular stapler through a 10-mm port and stapled off the apex with all the visible apical blebs. There were no remaining visible blebs left. Two areas had to be removed and sent for analysis. These were very thin-walled blebs.
The area was inspected. The lung showed no signs of other injury, no bleeding, no injury to any other structures. A 28-French straight chest tube placed, sutured in place. Proper position at the apex and talc was placed for mechanical pleurodesis. The trocars removed. Chest tube sites closed with Vicryl and staples. Chest tube sutured in place. No complications.
Initially, I was coding as 32655 but after more research I'm wondering if 32666 along with 32650(59) would be more accurate. Any suggestions?
OPERATIVE COURSE: Patient was taken to the operating room, timeout called, everyone agreed, anesthesia provided. Patient positioned and padded in the left lateral decubitus position with right side up. The old chest tube was removed and the patient was given antibiotics. The trocars placed without issue under direct visualization and the camera placed as well. Multiple apical blebs were identified, photographed. These were 3-4 cm in size greater than 5-6 in nature and in the apex. There were some adhesions and these had to be taken down with laparoscopic scissors and small Hemoclips without any significant bleeding whatsoever. I then placed an Echelon 60 white load vascular stapler through a 10-mm port and stapled off the apex with all the visible apical blebs. There were no remaining visible blebs left. Two areas had to be removed and sent for analysis. These were very thin-walled blebs.
The area was inspected. The lung showed no signs of other injury, no bleeding, no injury to any other structures. A 28-French straight chest tube placed, sutured in place. Proper position at the apex and talc was placed for mechanical pleurodesis. The trocars removed. Chest tube sites closed with Vicryl and staples. Chest tube sutured in place. No complications.
Initially, I was coding as 32655 but after more research I'm wondering if 32666 along with 32650(59) would be more accurate. Any suggestions?