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I advanced the needle towards the facet joint until I got good position of the needle into the AP, lateral and oblique view at the above levels. We had positive aspirate of yellow serous fluid from both joints and negative parethesia. I injected 1 ml of Omnipaque 300mg/mL, which showed good spread of the dye along the facet joint at the right L4-L5 and L3-L4. I had negative aspirate and negative paresthesia.
Thank you for any input
PREOPERATIVE DIAGNOSES: Dysphagia with risk of aspiration requiring
percutaneous endoscopic gastrostomy tube insertion. The patient has been off
Plavix for 5 days with still elevated Plavix screen report as of this morning
of moderate degree.
POSTOPERATIVE DIAGNOSIS:
1. Percutaneous endoscopic gastrostomy insertion without bleeding at the site of
the PEG site or internally at the PEG insertion.
2. Schatzki’s ring of mild degree in the distal esophagus. Caused some bleeding
on passing the tube requiring epinephrine injection and 1 clip at the distal
esophagus as well as application of cold water.
PREOPERATIVE MEDICATIONS: As per MAC anesthesia.
DESCRIPTION OF PROCEDURE: The patient was lying in the flat recumbent position
in the endoscopy room. After introduction of the Olympus gastroscope GIF-160
videoscope into the pharynx by, the scope was advanced into the
esophagus and easily into the stomach and subsequently into the duodenum.
Endoscopy findings show very mild degree of Schatzki’s ring at the distal
esophagus. The scope passed through it with ease. There was minimal degree of
gastritis. No polyp or ulcer was noted. The duodenum essentially was
unremarkable.
The abdominal wall was repaired by with sterile solution. The
transilluminated light was seen in the left mid epigastric area. Local
anesthesia was infiltrated with 1% Xylocaine. Trocar needle then was inserted
through which a guidewire was advanced. The wire was retrieved using
polypectomy snare. The snare together with the wire and the scope were removed
from the stomach into the esophagus and subsequently out of the mouth.
Boston Scientific size 20-French feeding tube was inserted over the cephalic
end of the wire and was advanced into the esophagus and subsequently pulled
through a small incision that was made at the same location. The tube shows
about 3 cm mark at the skin surface. A sterile dressing was applied.
On re-endoscopy by it shows some bloody material in the distal
esophagus. On further inspection, it seems to be possibly coming from the
Schatzki’s ring upon pulling the feeding tube. Epinephrine injection was
applied then 1 endoclip was applied as well. The bleeding continued for which
a lavage with cold water was performed which seems to control the bleeding.
Upon advancing the scope into the stomach the feeding tube site was normal and
no bleeding was noted. The patient tolerated the procedure generally well.
Does anyone know if a PRP injection can be coded separately from a tenotomy? If so, do you have any sources on this? I found a CPT Assistant article from May of 2012 which states that PRP can be coded separately with a tibial fracture nonunion repair, however I also found article from AAOS Now (August 2010) that states that the code is "to be used only when PRP is performed in a complete separate patient encounter from a surgical procedure". Any feedback would be appreciated.
Thank you!!
Does anyone know if a PRP injection can be coded separately from a tenotomy? If so, do you have any sources on this? I found a CPT Assistant article from May of 2012 which states that PRP can be coded separately with a tibial fracture nonunion repair, however I also found article from AAOS Now (August 2010) that states that the code is "to be used only when PRP is performed in a complete separate patient encounter from a surgical procedure". Any feedback would be appreciated.
Thank you!!
The Report reads: "The patient was placed in the supine position with the affected limb, with the shoulder in abduction and internal rotation, and the elbow flexed. We therefore, cleaned the radial aspect of the right elbow with chlorhexidine in the usual sterile fashion. We identified the right lateral epicondyle under ultrasound guidance. we advanced the 27-gauge needle. There was positive activation of the ulnar hypothenar muscle of the hand with the Stimuplex needle in place. Then had a negative aspiration and injected a total of 4 mL of lidocaine 1 %, as well as 40 mg of Depo-Medrol. Needle was removed. Dressing was applied."
If anyone has any guidance on this, it would be greatly appreciated.
thanks