toiwalker
Networker
I need alilttle help coding this....
PROCEDURE:
1. Stereotactic-guided and endoscopic-assisted resection of third ventricular tumor.
2. Placement of left frontal external ventriculostomy drainage catheter.
3. Removal right ventriculoperitoneal shunt.
The patient's bifrontal region was shaved, prepped and draped in standard sterile manner. The Brainlab neuronavigational system was utilized for preoperative planning as well as stereotactic guidance. The patient's prior right frontal ventriculoperitoneal
shunt incision was subsequently opened with a #I 0 scalpel blade. Self-retaining retractors were placed in the field. Hemostasis was obtained with a combination of bipolar and Bovie cautery. Immediately upon elevation of the flap, the previously placed right frontal ventricular shunt was identified, along with the valve and the left frontal ventricular shunt and Y connector comtecting these 2 systems. The Y connector was removed and forceps were applied to the left firontal ventricular shunt. The valve was subsequently disconnected and the entire distal catheter was subsequently removed. Next, the right frontal ventricular catheter was subsequently completely removed and sent for specimen. The right frontal burr hole was subsequently expanded utilizing the M2 drill bit and Stryker drill. Care was taken to remove all bony
debris. The dura was subsequently fenestrated in a cruciate manner and the edges coagulated. The peeled surface was subsequently coagulated. Utilizing sterotactic guidance, the #22-French peel-away introducer sheath was advanced over the stylet to approximately 5 em from the peeled surface. The stylet was removed and cerebrospinal fluid was encountered. Next, the Storz neuroendoscopic system was advanced and attached to the. The remainder of the procedure was performed \lllder endoscopic assistance.
Immediately upon entry into the ventricular system, significant amount of intraventricular adhesion was identified. There was a well-encapsulated gelatinous tumor identified in the region of the 3rd ventricle extending through tbe foramen of Monro. The thrombosed right veins were identified and care was taken to preserve these. There was an abundance of choroid plexus identified. The capsule of the tumor was subsequently coagulated using the monopolar cautery system,
and the wall of the tumor was subsequently incised and the tumor was internally debulked. Large pieces of specimens of
tumor were sent for histopathological analysis. The tumor has significantly mucinous appearance. Care was taken not to apply traction upon the floor of the tumor. The tumor was meticulously removed and hemostasis was obtained with monopolar cautery. After the tumor was completely removed, the foramen of Monro was identified and there was pulsatile cerebrospinal fluid flow through the foramen of Monro. The neuroendoscope and peelaway sheath were removed slowly under visualization and no hemorrhage was identified. Next, the incision was copiously irrigated with
saline. Artificial Gelfoam was placed in the burr hole. A burr hole cover was subsequently fixed from the Stryker plating system. The right frontal wound was sterilely washed and dried and the galea was subsequently approximated using intenupted 3-0 Vicryl suture and skin staples for skin approximation.
Next, tlte left frontal incision was reopened. Immediately upon opening of tlte old incision, the left frontal ventricular catheter was identified. Attempts to remove the ventricular catheter were subsequently made, however, significant resistance was encountered. The proximal ventricular catheter was noted to be fractured and the distal portion was successfully removed. Next, standard ventriculostomy catheter was advanced over the stylet to approximately 5 em from the peeled surface, and the stylet was removed, and cerebrospinal fluid was encountered. Specimen of cerebrospinal fluid was subsequently obtained and sent for histopathological analysis. The new catheter was subsequently tunneled approximately 2 em from the margin of incision and connected in a sterile manner to collection system. The wound was copiously irrigated and the galea was approximated using inte!Tupted 3-0 Vicryl suture. The skin was approximated using staples.
Both incisions were thoroughly washed and dried and sterile dressing was applied. The patient was subsequently removed from 3-point pin fixation. The patient was subsequently extubated and transferred to the intensive care unit in stable neurological condition without complication.
I was on the path to using codes 62258 61210 62201. Can some one give me their opinion please
PROCEDURE:
1. Stereotactic-guided and endoscopic-assisted resection of third ventricular tumor.
2. Placement of left frontal external ventriculostomy drainage catheter.
3. Removal right ventriculoperitoneal shunt.
The patient's bifrontal region was shaved, prepped and draped in standard sterile manner. The Brainlab neuronavigational system was utilized for preoperative planning as well as stereotactic guidance. The patient's prior right frontal ventriculoperitoneal
shunt incision was subsequently opened with a #I 0 scalpel blade. Self-retaining retractors were placed in the field. Hemostasis was obtained with a combination of bipolar and Bovie cautery. Immediately upon elevation of the flap, the previously placed right frontal ventricular shunt was identified, along with the valve and the left frontal ventricular shunt and Y connector comtecting these 2 systems. The Y connector was removed and forceps were applied to the left firontal ventricular shunt. The valve was subsequently disconnected and the entire distal catheter was subsequently removed. Next, the right frontal ventricular catheter was subsequently completely removed and sent for specimen. The right frontal burr hole was subsequently expanded utilizing the M2 drill bit and Stryker drill. Care was taken to remove all bony
debris. The dura was subsequently fenestrated in a cruciate manner and the edges coagulated. The peeled surface was subsequently coagulated. Utilizing sterotactic guidance, the #22-French peel-away introducer sheath was advanced over the stylet to approximately 5 em from the peeled surface. The stylet was removed and cerebrospinal fluid was encountered. Next, the Storz neuroendoscopic system was advanced and attached to the. The remainder of the procedure was performed \lllder endoscopic assistance.
Immediately upon entry into the ventricular system, significant amount of intraventricular adhesion was identified. There was a well-encapsulated gelatinous tumor identified in the region of the 3rd ventricle extending through tbe foramen of Monro. The thrombosed right veins were identified and care was taken to preserve these. There was an abundance of choroid plexus identified. The capsule of the tumor was subsequently coagulated using the monopolar cautery system,
and the wall of the tumor was subsequently incised and the tumor was internally debulked. Large pieces of specimens of
tumor were sent for histopathological analysis. The tumor has significantly mucinous appearance. Care was taken not to apply traction upon the floor of the tumor. The tumor was meticulously removed and hemostasis was obtained with monopolar cautery. After the tumor was completely removed, the foramen of Monro was identified and there was pulsatile cerebrospinal fluid flow through the foramen of Monro. The neuroendoscope and peelaway sheath were removed slowly under visualization and no hemorrhage was identified. Next, the incision was copiously irrigated with
saline. Artificial Gelfoam was placed in the burr hole. A burr hole cover was subsequently fixed from the Stryker plating system. The right frontal wound was sterilely washed and dried and the galea was subsequently approximated using intenupted 3-0 Vicryl suture and skin staples for skin approximation.
Next, tlte left frontal incision was reopened. Immediately upon opening of tlte old incision, the left frontal ventricular catheter was identified. Attempts to remove the ventricular catheter were subsequently made, however, significant resistance was encountered. The proximal ventricular catheter was noted to be fractured and the distal portion was successfully removed. Next, standard ventriculostomy catheter was advanced over the stylet to approximately 5 em from the peeled surface, and the stylet was removed, and cerebrospinal fluid was encountered. Specimen of cerebrospinal fluid was subsequently obtained and sent for histopathological analysis. The new catheter was subsequently tunneled approximately 2 em from the margin of incision and connected in a sterile manner to collection system. The wound was copiously irrigated and the galea was approximated using inte!Tupted 3-0 Vicryl suture. The skin was approximated using staples.
Both incisions were thoroughly washed and dried and sterile dressing was applied. The patient was subsequently removed from 3-point pin fixation. The patient was subsequently extubated and transferred to the intensive care unit in stable neurological condition without complication.
I was on the path to using codes 62258 61210 62201. Can some one give me their opinion please