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Thread: Help please for this surgery

  1. #1
    Join Date
    Apr 2007
    Kokomo, IN

    Default Help please for this surgery

    AAPC: Back to School
    I am at a loss as to how to code this. I keep coming up with unlisted codes, no matter how I go. I get 32120 for the reopening of the thoracotomy site, but the muscle flap repositioning keeps coming up unlisted. Can someone look at this please and see if they can find anything else? I'm brain dead today!!!

    This patient has been to surgery 4 times in 10 days at this facility.
    surgery #1 chest tube thoracostomy for residual right pneumothorax.
    surgery #2 (3 days later) thoracotomy with resection of bleb for ruptured bleb.
    Surgery #3 (3 days later) thoracoplasty for recurrent pneumothorax with persistant air leak.
    Surgery #4 (below) (4 days later)

    Right thoracotomy and repositioning of pectoralis major muscle flap.

    Dx: Malpositioned pectoralis major muscle flap.

    The patient was brought to the Operating Room, administered antibiotics and sequential compression devices were placed. After induction of general anesthesia the patient was placed in the left lateral decubitus position. The previous lateral thoracotomy incision was opened. The intercostal muscles were intact and we did not visualize the bovine pericardium placed by Dr. xxx. This was absolutely nowhere in our field. It was clear that the 2 fields from the pectoralis muscle flap incision and then the thoracotomy incision did not intersect. We thus exposed the lung and the pectoralis flap which was anteriorly placed and not over the area of air leak. We placed warm saline into the chest and confirmed that the air leak was still significant and at the apex. We thus placed the muscle flap, which did reach nicely over the apex. It was packed to the pleura at the apex to another segment of pleura where the pleural flap had been created, also near the apex and then onto 1 of the staple lines near the apex so that it was fixated over the area of the defect in a triangular type manner. It was without tension. The lung was inflated and it was found that there was no tension on the muscle flap. The chest tubes were irrigated and replaced. The incision was then closed with a running Vicryl suture for the intercostal and serratus anterior muscle layer. Again these layers were intact and were not interrupted with the pectoralis muscle flap operation. The skin and subcutaneous tissues were closed with a layer of running Vicryl suture and the skin was closed with staples. The patient tolerated the procedure well. There were no immediate complications. On initial bronchoscopy the patient had a large amount of bloody secretions. These were suctioned free and a toilet bronchoscopy will be performed by xxx prior to extubation.

    I appreciate anyone trying. Thanks!

  2. #2
    Join Date
    Apr 2007
    Albany, New York


    I also approached this several different ways and only come up with an "Unspecified" code for the flap repositioning.
    Karen Maloney, CPC
    Data Quality Specialist

  3. #3


    an unlisted code may be best for the "repositioning" of the flap.

  4. #4
    Join Date
    Apr 2007
    Kokomo, IN

    Default Thanks

    Thank you both for looking at this.
    Anyone else before I make my decision?
    I will probably end up with an unlisted code and I really hate using those, but sometimes I know it's unavoidable.

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