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Thread: Revision depressed abd scar - I could really use a second opinion on this case

  1. #1
    Join Date
    Apr 2007
    Posts
    76

    Default Revision depressed abd scar - I could really use a second opinion on this case

    Promo: Code Books
    Hi everyone,

    I could really use a second opinion on this case I am not sure if I should use just the closure CPT code or because excess skin was excised if I should use 15830??? Any in site will be much appreciated it.

    Thank you

    PREOPERATIVE DIAGNOSES:
    1. Postpartum involution of the breast.
    2. Depressed adherent abdominal scar.

    POSTOPERATIVE DIAGNOSES:
    1. Postpartum involution of the breast.
    2. Depressed adherent abdominal scar.

    PROCEDURE PERFORMED:
    1. Bilateral submuscular augmentation mammoplasty, inframammary
    approach (style 1600 Mentor saline inflatable prostheses; 375-mL
    implants filled to 390 mL on the left and 420 mL on the right).
    2. Revision, depressed adherent abdominal scar.

    ANESTHESIA: General with local infiltration.

    INDICATIONS FOR PROCEDURE: The patient is a 37-year-old female
    gravida 1, para 1 evaluated January of this year for breast surgery.
    She states that her breast volume went from a B cup to an A cup after
    having a child and wants to be a full C cup. She did not breastfeed.
    There is no family history of breast cancer. No personal history of
    breast problems. She has never had a mammogram, and does not smoke.
    Bra size is a 36A.

    The patient also states that she has a small pouch after a cesarean
    section, with skin overhanging. She works out 3-4 times a day but
    she cannot get rid of the excess skin. Even when her weight is less,
    she feels the scar is depressed.

    PERTINENT PHYSICAL FINDINGS: On examination of the breasts, reveals
    superior ptosis, left costal cartilages more prominent, the
    glandular tissue undifferentiated from the surrounding depressed
    tissue, without masses. Examination of the abdomen reveals an
    irregular low transverse scar, lower on the left side than on the
    right, with mild skin overhang and depression. The patient is
    brought to the operating room today for bilateral submuscular
    augmentation mammoplasty and scar revision.

    PREOPERATIVE LAB EXAMINATION: Within normal limits.

    DESCRIPTION OF PROCEDURE: With the patient in the standing position
    in the preoperative holding area, the area for scar revision of the
    abdomen was marked, as well as the inframammary folds. The patient
    was then brought to the operating room.

    After satisfactory general anesthetic induction, the chest was
    prepped and draped in the usual fashion. Inframammary incisions, 5
    cm long, were marked from the midline laterally at 5.5 cm below the
    nipple areolar complex. The subcutaneous space below the marked
    incision in the submuscular space was infiltrated with 0.5% Xylocaine
    with epinephrine. Both breasts were handled in a similar manner.

    The previously marked incision was incised with a 15 blade down to
    the subcutaneous tissue. The rest of the dissection down to the
    pectoralis fascia was done with the electrocautery unit with all
    bleeders being clamped and electrocoagulated as encountered. The
    pectoralis major muscle was then spread in line with its fibers and
    blunt finger and urethral sound dissection were done to elevate the
    submuscular space. Avulsion of the origin fibers of the pectoralis
    major muscle from 3 to 6 and 6 to 9 o'clock were done as indicated.
    Any bleeders were clamped and electrocoagulated. A saline tissue
    sizer was then placed into the pocket and filled to 400 mL. The
    pocket was then adjusted for conformity. The sizer was removed and
    an irrigation catheter was placed. The implant introduced into the
    pocket without difficulty with any further adjustment done as
    indicated. Closure of the muscular fascia was done with running 3-0
    Vicryl. Prior to final closure, 20 mL of 1/8% Marcaine was instilled
    into each pocket. The irrigation catheter was removed. The Vicryl
    was tied. Final closure was done with 4-0 PDS inverted interrupted
    subcuticular and running, Sterile dressings were applied.

    After completion of the breast augmentation, the abdominal scar,
    which had been previously prepped, was exposed by repositioning the
    drapes and the scar was then infiltrated with 0.5% Xylocaine with
    epinephrine. The scar was excised as well as approximately 1.5 cm
    laterally on each side. Incision was carried down through the skin
    and Scarpa's fascia to the plane anterior to the anterior rectus
    fascia using the electrocautery, and then dissection was carried in a
    cephalad fashion, releasing all adherence in the prior cesarean
    section. Bleeders were clamped and electrocoagulated. The skin was
    split in the midline, a height of 3.5 cm was split. Excess skin was
    excised. Bleeders were clamped and electrocoagulated, layered
    repair then done; 2-0 Vicryl Scarpa's fascia, 3-0 Vicryl deep
    subcutaneous subcuticular, running subcuticular 4-0 Monocryl.

    The patient tolerated the procedure well and was discharged to the
    recovery room awake, alert and in satisfactory condition. Blood loss
    was minimal.

  2. #2
    Join Date
    Apr 2007
    Location
    Atlanta
    Posts
    226

    Default

    cosmetic-19325-m-50

    and abdominal portion? It can be looked at as cosmetic 15830 or even medical scar revision reported with complex closure.

    So it really depends on whos paying for what, cpt can just be an indicator code for tracking purpose when cosmetic.

    MS

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