jdibble
True Blue
My surgeon performed this surgery and wants to bill code 39220 which I don't agree with, however I cannot find a code that would make him happy. Any ideas on how to code this would be appreciated!
Thanks,
Jodi
PREOPERATIVE DIAGNOSIS: Cervical and mediastinal lymphadenopathy.
POSTOPERATIVE DIAGNOSIS: Cervical and mediastinal lymphadenopathy.
PROCEDURE: Exploration of the mediastinum and anterior neck with
lymphadenectomy.
ANESTHESIA: General by mask.
SPECIMEN: Material forward to lab, right anterior deep cervical lymph nodes
and superior mediastinal lymph nodes.
INDICATIONS: A 53-year-old female who presented complaining of systemic
symptoms of malaise, muscle aches and pains, fevers and sweats and
specifically chest pain and right arm pain, numbness, and weakness. She had
been diagnosed 10 years prior with sarcoidosis by mediastinoscopy and had
never required treatment. Presently, her pulmonologist had doubts that the
current symptoms were secondary to sarcoidosis. She did have an MRI of her
brachial plexus, which showed lymphadenopathy in and around the brachial
plexus and the base of the right neck laterally, around the lateral aspect of
the right lobe of the thyroid, and in the superior and middle mediastinum.
Because of the doubts of the diagnosis, tissue for definitive testing was felt
to be necessary. She had no palpable cervical nodes on physical exam. She
now presents for operative intervention for lymphadenectomy.
FINDINGS: Multiple 5-8 mm round firm lymph nodes along the right paratracheal
area, extending down into the middle mediastinum. In the superior mediastinum
and at the base of the neck right side just lateral to the thyroid gland,
there was at 2-3 cm firm node. There was scar tissue extending around the
trachea and the mediastinum, presumably from a previous surgery.
DESCRIPTION OF PROCEDURE: Patient was taken to the main operating room, given
general anesthesia, prepped and draped in a sterile fashion. The previous
scar in the suprasternal notch at the base of the neck anteriorly from her
prior mediastinoscopy was entered sharply and the incision was carried down
through the skin and subcutaneous tissue onto the trachea itself. The
paratracheal space on the right side was bluntly dissected out, taking care to
avoid the palpable blood vessels. There was some scar tissue in this area,
presumably from previous surgery, but the dissection was continued
meticulously and safely.
Palpation along the right peritracheal area did reveal several 5-8 mm firm
round nodes. They were deep in the superior mediastinum and visualization
through the incision was poor, but with palpation and by grasping with a right
angle clamp, several of these nodes were able to be teased free from the other
tissue and brought up and out through the incision. They were collected as
lymph nodes from the anterolateral right side mediastinum.
Further palpation up into the lower aspect of the deep cervical region on the
right side revealed that lateral to the thyroid gland there was a 2 cm firm
rubbery node. This node was bisected and half of it was sent as a specimen
along with the other lymph nodes. Hemostasis was obtained deep in the
pretracheal space with packing and eventually with Surgicel. Hemostasis was
obtained in the visible wound depth with the electrocautery and 3-0 Vicryl
suture ligatures. Good hemostasis was obtained.
The deep subcutaneous tissue was then closed with interrupted 3-0 Vicryl
sutures. Skin was closed with interrupted subcuticular 4-0 Biosyn sutures.
Dermabond was applied to the skin as a sealant. Patient tolerated procedure
well. No operative complications. Blood loss minimal. Specimen, superior
mediastinal and deep right cervical nodes. Patient was taken to the
postanesthesia care unit in good condition.
Thanks,
Jodi
PREOPERATIVE DIAGNOSIS: Cervical and mediastinal lymphadenopathy.
POSTOPERATIVE DIAGNOSIS: Cervical and mediastinal lymphadenopathy.
PROCEDURE: Exploration of the mediastinum and anterior neck with
lymphadenectomy.
ANESTHESIA: General by mask.
SPECIMEN: Material forward to lab, right anterior deep cervical lymph nodes
and superior mediastinal lymph nodes.
INDICATIONS: A 53-year-old female who presented complaining of systemic
symptoms of malaise, muscle aches and pains, fevers and sweats and
specifically chest pain and right arm pain, numbness, and weakness. She had
been diagnosed 10 years prior with sarcoidosis by mediastinoscopy and had
never required treatment. Presently, her pulmonologist had doubts that the
current symptoms were secondary to sarcoidosis. She did have an MRI of her
brachial plexus, which showed lymphadenopathy in and around the brachial
plexus and the base of the right neck laterally, around the lateral aspect of
the right lobe of the thyroid, and in the superior and middle mediastinum.
Because of the doubts of the diagnosis, tissue for definitive testing was felt
to be necessary. She had no palpable cervical nodes on physical exam. She
now presents for operative intervention for lymphadenectomy.
FINDINGS: Multiple 5-8 mm round firm lymph nodes along the right paratracheal
area, extending down into the middle mediastinum. In the superior mediastinum
and at the base of the neck right side just lateral to the thyroid gland,
there was at 2-3 cm firm node. There was scar tissue extending around the
trachea and the mediastinum, presumably from a previous surgery.
DESCRIPTION OF PROCEDURE: Patient was taken to the main operating room, given
general anesthesia, prepped and draped in a sterile fashion. The previous
scar in the suprasternal notch at the base of the neck anteriorly from her
prior mediastinoscopy was entered sharply and the incision was carried down
through the skin and subcutaneous tissue onto the trachea itself. The
paratracheal space on the right side was bluntly dissected out, taking care to
avoid the palpable blood vessels. There was some scar tissue in this area,
presumably from previous surgery, but the dissection was continued
meticulously and safely.
Palpation along the right peritracheal area did reveal several 5-8 mm firm
round nodes. They were deep in the superior mediastinum and visualization
through the incision was poor, but with palpation and by grasping with a right
angle clamp, several of these nodes were able to be teased free from the other
tissue and brought up and out through the incision. They were collected as
lymph nodes from the anterolateral right side mediastinum.
Further palpation up into the lower aspect of the deep cervical region on the
right side revealed that lateral to the thyroid gland there was a 2 cm firm
rubbery node. This node was bisected and half of it was sent as a specimen
along with the other lymph nodes. Hemostasis was obtained deep in the
pretracheal space with packing and eventually with Surgicel. Hemostasis was
obtained in the visible wound depth with the electrocautery and 3-0 Vicryl
suture ligatures. Good hemostasis was obtained.
The deep subcutaneous tissue was then closed with interrupted 3-0 Vicryl
sutures. Skin was closed with interrupted subcuticular 4-0 Biosyn sutures.
Dermabond was applied to the skin as a sealant. Patient tolerated procedure
well. No operative complications. Blood loss minimal. Specimen, superior
mediastinal and deep right cervical nodes. Patient was taken to the
postanesthesia care unit in good condition.