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Old 05-26-2011, 10:55 AM
KELLI KELLI is offline
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Default Revision depressed abd scar

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

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

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

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.


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.
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Old 05-27-2011, 10:34 AM
surgonc87's Avatar
surgonc87 surgonc87 is offline
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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.

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