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OP Note:
Neuroplasty of right lateral femoral cutaneous nerve distal to the inguinal ligament
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Neurectomy of the right lateral femoral cutaneous nerve and the retroperitoneal space.
patient was taken to the operating room and placed in supine position. Right side of the abdomen and right proximal thigh were prepped and draped in normal fashion. Timeout performed.
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A retroperitoneal exposure was performed by the general surgery service as co-surgeons for this procedure.
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As we explored the retroperitoneal space and the area along the iliac is possible we’re unable to clearly identify the lateral femoral cutaneous nerve. This was likely secondary to previous surgery and some scarring. The incision was undermined and we started to expose more distally along the inguinal ligament. At the junction of the inguinal ligament and the anterior superior iliac spine, dissection proceeded. We moved just distal to the inguinal ligament and were able to identify the lateral femoral cutaneous nerve as it was exiting from under the ligament into the thigh. We then traced the nerve proximal under the inguinal ligament towards the retrograde peritoneal space. This allowed us to then identify the nerve In the retroperitoneal space. Gentle neuroplasty was now performed as we exposed the nerve over at least a distance of 2-3 cm In the retroperitoneal space. This was proximal to the likely pathology for the patient.. The nerve was fully divided. The proximal stump was then rotated and a opening was placed in the iliac’s muscle. Proximal stump was then buried into the muscle.
Thanks so much,
Tracy
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Don’t let procedural coding intimidate you; it may turn out to be your preferred code set. I admit it: I was very intimidated at the thought of using a procedural coding system (PCS), at first. Prior to Oct. 1, 2015, I coded inpatient procedures using ICD-9-CM Volume 3 codes, which were three to four numeric […]
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Does anyone know if you can still report 60505 (Parathyroidectomy or exploration of parathyroid(s); with mediastinal exploration, sternal split or transthoracic approach) if the physician uses a cervical approach not a sternal or transthoracic approach? Or would I still report 60500 because of the approach and/or the location of the tissue being in the superior aspect of the mediastinum? The physician removed a parathyroid adenoma from the superior mediastinum.
Op report reads:
The patient was taken to the operating room and placed supine on the operating table. General endotracheal anesthesia was provided by the anesthesia service. A NIMS endotracheal tube was used. Two NIMS grounding electrodes were placed sterilely in the chest wall. TED hose and SCDs were placed on his lower extremities and blood was obtained for baseline intraoperative parathyroid hormone testing. The patient’s neck was positioned in an extended fashion and the bed was placed in lounge chair position. His neck was prepped and draped in a sterile fashion and timeout was performed. A 15 blade scalpel was used to make a 4 cm transverse cervical incision. Electrocautery was used to dissect through the platysma. Subplatysmal flaps were raised and the strap muscles divided in the midline. The Strap muscles were dissected free from the underlying left thyroid lobe. The lobe was retracted medially, the carotid sheath was opened, and function of the recurrent laryngeal nerve was confirmed by NIMS probe stimulation of the vagus nerve. The paratracheal space was examined and an adenomatous appearing parathyroid gland was identified lateral to the esophagus in the superior mediastinum. The left superior pole parathyroid adenoma was dissected off of the underlying vertebral body and its blood supply was divided with the Harmonic Scalpel. Blood was obtained for intraoperative parathyroid hormone testing at 5, 10, and 20 minutes post excision of the parathyroid adenoma. Valsalva maneuver x 2 was performed. Hemostasis was assured.
If the hospital pays for and supplies the equipment used for the computed assistance can the surgery charge for it? Example 27130(THR) with add on code 20985. He does use the it but does not supply it. The surgeon does not work for the hospital.