2. Explain why you chose the ICD-9/ ICD-10 and CPT code for each answer. 3. Focus on why you chose the answer and the fu
Posted: Fri May 06, 2022 9:13 am
- 2 Explain Why You Chose The Icd 9 Icd 10 And Cpt Code For Each Answer 3 Focus On Why You Chose The Answer And The Fu 1 (30.29 KiB) Viewed 37 times
- 2 Explain Why You Chose The Icd 9 Icd 10 And Cpt Code For Each Answer 3 Focus On Why You Chose The Answer And The Fu 2 (92.65 KiB) Viewed 37 times
- 2 Explain Why You Chose The Icd 9 Icd 10 And Cpt Code For Each Answer 3 Focus On Why You Chose The Answer And The Fu 3 (24.86 KiB) Viewed 37 times
BOND, MD PREOPERATIVE DIAGNOSIS: Carcinoma of the left breast. POSTOPERATIVE DIAGNOSIS: Same. PROCEDURE PERFORMED: Left total mastectomy and left axillary node dissection. (This is a modified radical mastectomy.) HISTORY: Patient underwent left breast biopsy for suspicious lesion 2/10/XX. Pathology report returned with diagnosis of adenocarcinoma of breast. Patient and her family discussed the benefits of the proposed total mastectomy and the risks, including death. Patient gives her understanding and agrees to proceed with the proposed procedure. PROCEDURE: With the patient in the supine position under good general endotracheal anesthesia, a folded towel was placed beneath her left scapula and her left arm abducted on a pillow. She was prepped thoroughly with Betadine; the extent of her mastectomy incision was marked with a marking pen. We went about half an inch superior and half an inch inferior to her most medial circum-mammary incision, and it was a transverse incision. The draping was completed with Minnesota Mining drape and sterile paper in the usual manner. The superior flap was raised first. Bleeders on the breast were clamped and bovied; small bleeders on the flap were clamped and tied with 3-0 silk. The superior flap was raised to the clavicle inferior to the rectus sheath, medially to the sternal border, and laterally to the latissimus dorsi. The breast was outlined with a bovie, and then the breast was removed medially and laterally. We were somewhat concerned about involving the pectoralis muscle here, but it did not, and we could not see any invasion to the pectoralis fascia. Perforators were clamped and oversewn with 2-0 silk figure-of-eights. Small bleeders on the pectoralis major were bovied. The breast was allowed to fall laterally. The clavipectoral fascia was taken down. There was an area of scar tissue on the superior lateral portion of the pectoralis major attached to the breast, and we thought this was in the area of the previous biopsy. We had to dissect this off sharply, and it did not appear to be a cancer. Then she had a lot of inflammatory tissue in the axilla, which was rather difficult to define, but we exposed the axillary vein, hemoclipped the small venous tributaries, and dissected the axilla down to the 7th rib, and then took the breast off the serratus by bovie; the lateral chest bleeders were clamped and tied with 3-0 silk. The axilla was inspected, and the long thoracic and thoracodorsal nerve was intact. We left the superior branch of the intercostal brachial. It was dry. The mastectomy site was lavaged out with a liter of sterile water. Small bleeders were bovied. Several bleeders on the flaps were clamped and tied with 3-0 silk. The chest tubes were placed in the axilla and over the pectoralis major and exited laterally inferiorly, and the flaps were brought together without any tension
with pulley sutures of 2-0 silk; then the wound was closed with a running 4-0 Prolene vertical mattress suture, removing the pulley sutures as we went. Vaseline dressings and dry dressings were applied. Estimated blood loss was 400 ml. She tolerated this well. The flaps seemed to be intact. The drains were sewn into place and dry dressings applied. She tolerated the procedure well and was returned to the recovery room in good condition.