Code the following using ICD-IO-CM and ICD-IO-PCS Preoperative Diagnosis: Bronchial alveolar cell carcinoma of the right

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Code the following using ICD-IO-CM and
ICD-IO-PCS
Preoperative
Diagnosis: Bronchial alveolar cell carcinoma of the right
lower lobe of the lung
Postoperative
Diagnosis: Same
Operation:
Exploratory right thoracotomy. Right pneumonectomy
Procedures: This
patient was operated on under general endotracheal anesthesia.
we had a double
lumen tube in where we could selectively ventilate both lungs. He
was in the lateral decubitus position. we used a standard posterior
lateral right thoracotomy incision and the chest was opened. There
was one adhesion to the apical area which was not neoplastic in any
manner. I took this down and we were able to easily mobilize the
lung. There was a large diffuse lesion in the right lower lobe
periphery. I really did not know what to do with this. The lesion
had previously been biopsied, and we thought we were dealing with a
bronchial alveolar cell. The man did have a past history of
non-Hodgkin's lymphoma years ago which was presumably cured. I
began dissecting on the pulmonary artery to look at things to see
what kind of fissure I had developed, but the inner lobar branches
were just too dense, that is, there was no fissure basically and I
knew if I did a lobectomy it was really entering the tumor area
peripherally. I therefore went ahead and elected to do a right
pneumonectomy since his pulmonary function studies were
satisfactory pre-op, and this was the best thing I thought. The
main pulmonary artery was divided between a vascular staple gun.
Dissection was a little tenuous. The artery seemed quite friable
but it held nicely. I then reinforced this with a large Chromic
tie. We divided the superior and inferior pulmonary vein and
prepared for clamping of the bronchus. This completed the
pneumonectomy. He lost some blood due to a bleeding adhesion up
above which was not recognized until he had about a half a unit of
blood in the left upper chest. This was suctioned clean and we
transfused him with two units of packed cells. He tolerated the
procedure well. He had some hypotension but he was hypotensive on
induction throughout the entire procedure. Blood gases were
satisfactory during clamping of the mainstem bronchus, and he
seemed to be reacting well. We closed the chest in layers with
Dexon pericostal sutures, approximated clips on the skin.
Code(s):