• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
  • Important Note: We will be performing a scheduled maintenance on 1st November 2020. The site will be offline from 7:30PM (MT) till midnight. We apologize for any inconvenience this may cause.

Venous access device insertion with revision of left mastectomy incision

ksb0211

Guru
Messages
143
Location
Deltona, FL
Best answers
0
This one has been debated in our office. Just looking for other opinions. Thanks for any advice.

POSTOPERATIVE DIAGNOSES
Metastatic carcinoma, left breast, with involved inferior margin status post left mastectomy.

OPERATION PERFORMED
Venous access device insertion on the right with revision of left mastectomy incision.

DESCRIPTION OF PROCEDURE
The patient was taken to the OR, after induction of adequate anesthesia, the patient was prepped with DuraPrep and draped sterilely. The venous access device placement was performed first. The skin was injected with 0.5% Marcaine in the right subclavian area. The introducing needle was passed beneath the clavicle and subclavian vein. The guidewire was introduced without difficulty. This was visualized fluoroscopically and interpreted intraoperatively by myself. With this completed, the pocket was formed over the anterior chest wall. The introducer was passed over the wire. The catheter utilized is a T port, reference #616.365.2081-A, lot #112170000. The placement of the tip was noted to be appropriate and at the junction of the superior vena cava and right atrium. The port was secured with 3-0 silk suture into the pocket. The pocket was then closed. Incision closed with 2-0 Vicryl to the deep tissue and a 4-0 Vicryl subcuticular stitch. Steri-Strips and Tegaderm applied. The patient tolerated the procedure.

With this completed, attention was turned to the left side. The skin was marked so as to excise the inferior aspect of the mastectomy incision. The skin was incised. A flat plane was developed so that I took a very thin shelf of tissue from the flap on the inferior aspect of the mastectomy scar. The specimen was then passed off. The wound was thoroughly irrigated with antibiotic solution. The 7 mm Jackson-Pratt drain was then placed. The wounds were injected with Marcaine and then the wound was reapproximated with interrupted 3-0 Vicryl suture. Clips were placed in the skin. A dry sterile dressing was applied. The patient tolerated the procedure. Final pathology is pending at this time.
 

ksb0211

Guru
Messages
143
Location
Deltona, FL
Best answers
0
LOL. Sorry. Just looking for opinions on how this should be coded. The suggestions around here have ranged from 19499,36571 to 19301,36561 and a few other choices.
 
Top