Removal of retained sutures anterior cornea right eye cpt code

CHAPTER 26 r Endocrine and Nervous Systems

PRACTICAL

Using the CPT manual, code the following:

2l.Incisionanddrainageofaninfectedthyroglossalductcyst.

& cpr code(s):

lr. *"^ovar of a complete cerebrospinal fluid shunt system; without replacement.

& cpr code(s):

23. Suture of the posterior tibial nerve'

& cpr code(s):

T. w^bar sympathetic block (left)'

CPT Code:

25. Mioodissection, microrepair ulnar digital nerve teft middle frnger'

CPT Codes:

4u. n ur"*ent of a dorsal column stimulator with implanted generator, with stereotactic stimulation of spinal cord'

27. Epidual iniection of a steroid, caudal'

ur/g. aruniotomy for drainage of an intracranial abscess; infratentorial.

CPT Code:

due to leak of CSF29. Re-opetation, skull base surgery, repair of dura matel

of miOdte cranial fossa; myocutaneous flap graft'

.,a/0. ,.rr.r,ion of a cerebrospinal fluid ventriculoperitoneal shunt for

hydrocephalus.

CPT Code:

31. Hemilaminectomy, posterior approach, with decomqr-elsion of two

"- ;.-re;ooi, u"O #ittr excision bi herniated disc atLl-LZ and foraminotomy at L2-L3'

CPT Codes:

B ur." to decide number of codes necessary to correctly arrswer the question.

odd-numberedanswersarelocatedinAppendixB,whilethefullanswerkeylsonlyavailableintheTEACll Instructor Resources on Evolve'

iopyright @ 2015 by Saunders, an impdnt of Elsevier Inc' A11 rights reserved'

CHAPTER 26 r Endocrine and Nervous Systems

REPORTS

In Appendix A of this workbook you will find a section titled Repotts, which contains original reports. Read the rcports indicated below and supply the ilppropriate CPT and ICD-10-CM/ICD-9-CM codes on the following lines:

J32. Report 4t

CPT Codes: (arthrodesis with discectomy),

(arthrodesis with discectomy),

(instrumentation), (allograft),

(evoked potential)

ICD-10-CM Code:

(ICD-9-CM Code:

33. Report 43

& code(s):

& tco-ro-cM code(s):

(& ICD-o-cM code(s):

& U".. to declde number of codes necessary to correctly answer the questlon. Odd-numbered answers are located ln Appendlx B, while the full answer key is only available il the TEACH Instructor Resources on Evolve.

Copydght @ 2015 by Saunders, an impdnt of Elsevier Inc. All rights reserved.

APPENDIX A r RePorts

stapleL We imbricated the staple line with two Ethibond sutures, placed a wad of fat over the last to adhere the fat neal oul staple line. We tested the anastomosis with air with the bowel clamped, and there was no evidence of a leak. We then placed Hemaseel ovel this anastomosis, and then once again mobilized the mesentery. We then closed the mesenteric defect where the small bowel had gone in retrogastric fashion with the Ethicon Endo- suture. We once again placed Hemaseel on our small anastomosis. We placed L0 flat Jackson-Pratt drains near our GJ anastomosis, which came on out the Ieft side. We removed the trocal polts under direct vision. We then extended our umbilical incision and reduced the umbilical hernia. We closed the fascial defect with interrupted 0 Prolene sutures. We anesthetized the wounds at all aleas with a total of 60 cc of 0.50o/o Sensorcaine with epinephdne solution. We secured the drains in place with 0 silk sutures and then closed the skin with 3-0 Prolene sutures. Steri-Strips and sterile Band- Aids were applied. All sponge and needle counts were correct. We left the taut catheter and a Penrose drain in the left midclavicular line incision.

AtI sponge and needle counts were correct. She tolerated this well and was taken to recovery in stable condition.

PATHOLOGY RBPORT LATER INDICATED: See Report 63.

IIISTORY: This patient, who is unknown to me, reports working in the shop at his home grinding metal approximately 5 hours ago. He was wearing safety glasses, but he has noticed a foreign body in his right eye. He reports slight irritation to the eye. Denies blurred vision.

PHYSICAL EXAMINATION: PERLA, tundi without edema. There was no foreign body on lid eversion. Slit lamp shows a foreign body approximately 2 to 3 o'clock on the edge of the cornea. This foreign body appears metallic. There is very small area of rust around the site. Iris is intact. There are no cells in the anterior chamber. Fluorescein dye reveals uptake only over foreign body.

PROCEDURE: Two drops of Alcaine were used in the right eye. Foreign body was removed with an eye spud without difficulty. Slight orange discoloration at the base of cornea, but no definite rust ring visible.

IMPRESSION: Residual corneal abrasion.

DISPOSITION: Foreign body removed from right eye.

PREOPERATM DIAGNOSIS: Left cervical spondylosis, C5-6, C6-7, with cervical discs.

POSTOPERATM, DIAGNOSIS: Same.

PROCEDURE PERFORMED: Anterior discectomy and osteophytectomy for decompression at C5-6 and C6-7 , with allograft fusion and Zephyr plating.-

This case was monitored with sensory evoked potentials throughout the case. There were no changes.

PROCEDURE: Under general anesthesia, the patient was placed in the cervical outfigger. The neck was prepped and draped in the usual manner.

Copyright @ 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.

APPENDIX A r Reports

1.

2. 3.

An incision was made parallel to the sternocleidomastoid, and then we got onto the omohyoid and incised this. Then with sharp dissection we got onto the prevertebral fascia, put the Farley-Thompson retractor in, and then I was able to localize the C5-6 and C6-7 interspaces. The plan here was to decompress the nerve roots and get rid of the ridges, the disc, and to fuse and p1ate. The discectomies were done at C5-6 and C6-7. The ridges were removed, the discs were removed, and then the cartilaginous surfaces were prepared for reception of the bony fusion. At C6-7, a #8 trial was utilized and at C5-6 a #7 trial was utilized with bone. I took off the ridges, I took off the osteophytes, I removed the discs. I got down to the dura on both sides and was satisfied now that the nerve roots were decompressed and I could put the trial in and place the structural bone graft in. This was done at both Ievels. This having been done, they were countersunk and I then utilized a Zephyr plate from C5 down to C7 and put a screw into C6 as well. This done, a Hemovac drain was placed into the wound. Of course, the plate was locked, and we then closed the wound in layers utilizing 2-0 chromic on the platysma with 2-0 plain in the subcutaneous tissue and 3-0 nylon interrupted mattress sutures on the skin. A dressing was applied. The patient was to wear a collar in the postop period.

PATHOLOGY REPORT LATER INDICATED: Benign bone and tissue.

PREOPE,RATfVE DIAGNOSES:

Ptosis, right upper lid. Loss of superior visual field secondary to #1. Superior hemianopia secondary to #1, right eye.

POSTOPERATM DIAGNOSES: Same.

PROCEDURE, PERFORMED: Fasanella-Servat procedure, right upper lid.

ANESTHESIA: General endotracheal.

INDICATIONS: This S7-year-old white female has had progressively drooping lid on her right for many years which has now reduced her superior visual field in the right eye and has actually limited her vision. After the prior approval and the photos and documentation were obtained, it was noted that the patient did have a 3- to 4-mm ptosis of the right upper lid and we would approach this with a Fasanella-Servat procedure. The risk of infection, hemorrhage and reoperations were discussed.

PROCEDURE: After the patient was placed under suitable general endotracheal anesthesia; the superior tarsal border was then marked with a marking pen and a 15 Bard-Parker blade cut down through skin to the muscle area. The lid was then everted on a Desmarres retractor and two curved mosquitos were then placed with the point central and pointing superiorly when the lid was everted. A 6-0 gut rapid absorbing suture was then started through the skin incision at the superior tarsal border and then a purse string was then woven along the curve tips and then the 3 to 4 mm resection was then obtained and then the serpentine 6-0 gut suture was then approximated without cutting it and brought out through the skin and tied. It was allowed to retract into the knot. There was no bleeding and there was no cut suture. Maxitrol ointment, a Telfa pad, and patch was applied and the patient was sent to the recovery room