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Tag Archives: exchange

Breast implant exchange

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Need help with coding. Would it be 19340?

Indications for Surgery: 13 weeks status post replacement of bilateral breast implants with revision to prepectoral pocket. She developed a right breast incision dehiscence with cellulitis postoperatively. Her cellulitis was easily controlled, and she has been maintained on oral antibiotics prophylactically. She presents now for implant removal, washout, implant replacement and scar revision. She is aware that she will run increased risk of future infection. *Risks will also include hematoma, seroma, further wound healing issues, scarring, asymmetry, implant loss and need for further surgery.*and I reviewed the*nature, purpose, benefits, usual and most frequent risks of, and alternatives to, the operation or procedure. **The patient had an opportunity to ask questions, and those questions were*answered. Informed consent was then obtained.
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Operative Procedure: I began by injecting 30 cc of 0.25% marcaine with Epinephrine into the planned area of incision. On the right I excised a 7 cm long ellipse to completely remove the skin around the dehisced incision. This allowed me to come back to healthy bleeding skin edges. The patient’s intact saline implant was then ruptured and removed. The pocket was inspected and there was no purulent material identified. In fact there was no fluid seen within the pocket at all. The pocket was then copiously irrigated with 3 L of normal saline using a Pulsavac. Antibiotic irrigation was used with 500 cc NS and 1 gram ancef, 80 milligrams gentamycin, and 50,000 units of bacitracin. Following this my gloves were changed. A Mentor smooth round moderate plus profile saline implant style 2000 was then placed. It was expanded to 1100 cc using sterile saline. The implant capsule was then closed using 3-0 Vicryl suture. The skin was closed in layers using 3-0 Vicryl in the dermis and 4-0 Monocryl running subcuticular suture. Dermabond prineo was placed. A surgical bra was placed. The patient was awoken from anesthesia without complication and transferred to the recovery room in stable condition. At the end of the case all the needle, sponge and instrument counts were correct x 2 and I was present for the entire case.
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thank you

Medical Billing and Coding Forum

PPV with Silicone Oil EXCHANGE

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Good Afternoon,

My retinal physician has performed a removal of silicone oil, as well as a PPV with placement of silicone oil.

My first thought would be to bill 67036 since the removal of the oil (67121) is bundled with the PPV, but the physician would like to bill something else for the secondary placement of oil. I was considering 67042, but there is no/3 but there is no mention of any type of membrane removal.

Any advise on this would be greatly appreciated.

Thanks!!!

Medical Billing and Coding Forum

North Carolina Providers: Don’t Miss Health Information Exchange Deadlines

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Healthcare providers in North Carolina who receive state funds for the provision of healthcare services are facing important deadlines to begin using their state’s dedicated health information exchange (HIE), called NC HealthConnex. For most providers, the deadline to connect and submit patient clinical and demographic date to NC HealthConnex is June 1, 2019. NC HealthConnex […]
AAPC Knowledge Center

Flex Sigmoidoscopy, drain exchange and sinus debridement

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Hi. Having a hard time figuring this one out! Reason to take the patient to the OR was to replace the mushroom catheter/drain which ended up taking substantial time. Below is the op note. Any help in coding this drain exchange and/or sinus debridement is appreciated. Thanks!

Indications: Chronic presacral sinus secondary to anastomotic leak.

Description of Procedure: The patient was brought to the abdomen placed on the operative table in supine position. After administration of adequate anesthesia the patient was placed in lithotomy position. The patient was prepped and draped in usual sterile fashion. Timeout was performed. The patient received preoperative antibiotics in the form of Flagyl. The perianal area was injected with 30 mL of 1% lidocaine with epinephrine and 0.5% Marcaine mixed. Digital rectal examination revealed the drain was in a posterior presacral cavity. Perianal examination revealed no masses. No fistula or fissure. Digital rectal examination did not reveal any clear mass. The rectum proximal to the area of the posterior sinus was collapsed and scarred down. The drain was then removed in its entirety. The area of the posterior sinus was then probed. Passage of the new catheter which was a 12 French mushroom catheter was very difficult. Because of the angulation and granulation tissue present was difficult to advance the catheter. Approximately 1 hour was spent attempting to do this. Finally the area of the sinus was debrided bluntly and sharply. Granulation tissue was evacuated. A flexible sigmoidoscopy was performed up to the level of the collapsed rectum. There was no signs of mass. Biopsies were taken. Colonoscope was removed. The 12 French mushroom drain was then placed within the cavity. It appeared to stay in place. It was then secured to the left buttock with a 0 silk stitch. The perianal area was then cleaned dried and dressings applied. The patient was then awakened from anesthesia in stable condition.

Medical Billing and Coding Forum

Exchange of hardware?

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Coding gurus, I’m at a loss on this one. We had a patient that had ORIF of a proximal humerus fracture and then, a month later had a second procedure.
Indications: Prominent hardware and suture abscess.
Operation Performed: Left shoulder superficial I and D with exchange of proximal locking screws.

Should I code unlisted for the hardware exchange, or could I code repeat ORIF with reduced services?

Description of procedure:
“…….no fluid collection or purulence was found in the subcutaneous or deep tissues. The areas around the suture abscess was cultured anyway. This area was copiously irrigated and the soft tissues were dissected to ensure there were no pickets of infection or purulence. After utilizing the deltopectoral interval, the proximal portion of the previously placed plate was exposed. The fracture site was palpated and found to be firm and stable. The C-arm was sterilely draped and brought onto the field and screws, which appeared to be threatening the penetration of the subchondral bone were identified and removed. These were then exchanged for shorter screws with the aid of fluoroscopy to ensure appropriate length”

Thanks,
Tobi C.

Medical Billing and Coding Forum

Stent Exchange Diagnosis Codes

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We do a number of ureteral stent exchanges in our ASC. The ICD-10 diagnoses I assign are T19.1XXA, Z46.6 with the 3rd one being the reason for the stent to begin with … with hydronephrosis being the most common. My question is two-fold.

1. Does it matter what sequence the codes are in?
2. For those patients that have the stent permanently and return for an exchange every 6 months or so…should the 7 character to a D?

Thanks for any assistance you can provide.

Medical Billing and Coding Forum

implant exchange

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I am trying to code the following op note:
Op performed: implant exchange of the right breast capsulotomy and fat grafting.

Technique: there was a 325ml saline implant, electrocautery was used to perform a capsulotomy, the rest of the capsule opened. A 555cc implant was chosen, placed in the right breast with good symmetry to the left breast. Attention was then drawn to the abdomen, stab incisions were made at the anterior superior iliac crest, at the umbilicus, midaxillary line at the mid abdomen. Tumescent solution was then placed. Liposuction was then performed through various openings of the abdominal wall, the hips, the flanks and the thighs. This gathered up 300ml of usable fat graft, which was injected in the right breast in the superior pole, and some in the medial. Liposuction incisions were then closed with deep dermal suture and skin closed.

Patient previously had a masectomy with reconstruction done in 2004. The left breast has continued to grow while the right breast is way too small.

These are the codes that I have picked: 19340(immediate insertion of breast implant), 19380(revision of reconstructed breast), 11954(injection of the fat into the breast), 15877(liposuction of the trunk), 15879(liposuction of the lower extremities)

Diagnosis code: N65.0……I was not going to mention about the history of cancer since the surgeon did not mention it in the op notes, the surgeon only mentioned previous breast reconstruction in 2004

Can anyone offer any help or insight?

Medical Billing and Coding