Dr. Manning, a thoracic surgeon, was asked to consult with Nancy, a 66 year old female with atherosclerotic heart disease. The patient, who requested the visit, is well known to Dr. Manning, who performed thoracic surgery on her two years ago. She was seen in his office Monday morning for a consultative visit with mild complaints of fatigue and shortness of breath. Dr. Manning dictated comprehensive history, comprehensive examination, and high- complexity decision making. During this consultation, Dr. Manning made the decision to re-operate on Nancy. He sent a written report back to her cardiologist, Dr. Shaw, regarding the need for the another surgery to take place the following day. Monday evening, Nancy was admitted to the hospital to start the pre for the planned bypass surgery Tuesday morning.
Tuesday's operative report
Preoperative diagnosis: Atherosclerotic heart disease
Postoperative diagnosis: Same
Anesthesia: General
Procedure: The patient was brought to the operating room and placed in the supine position. With the patient under general intubation anesthesia, the anterior chest, abdomen and legs were prepped and draped in the usual fashion. Review of a postoperative angiography showed severe, recurrent, two-vessel disease with normal ventricular function. A segment o the femoropopliteal artery was harvested using endoscopic vein- harvesting technique and prepared for grafting. The patient was heparinized and placed on cardiopulmonary bypass. The patient was cooled as necessary for the remainder of the procedure and an aortic cross-clamp was placed. The harvested vein was anastomosed to the aorta and brought down to circumflex and anastomosed into place. An artery was anastomosed to the left subclavian artery and brought down to the left anterior descending and anastomosed into place. The aortic cross-clamp was removed after 55 minutes with spontaneous cardio version to a normal sinus rhythm. The patient was warmed and weaned from the bypass without difficulties after 104 minutes. The patient achieved homeostasis. The chest was drained and closed inlayers in the usual fashion. The leg was closed in the usual fashion. Sterile dressings were applied and the patient returned to intensive care recovery in satisfactory condition.
How should Dr. Manning report is services for Monday and Tuesday in this case?
a) Monday: 99255-57; Tuesday: 33511, 33517, 35600
b) Monday: 99215-57; Tuesday: 33533, 33517-57, 35572-80, 33530-51
c) Monday: 99255-57; Tuesday: 33533, 33510, 33572, 33530
d) Monday: 99215-57; Tuesday: 33533, 33517, 35572, 33530
Tuesday's operative report
Preoperative diagnosis: Atherosclerotic heart disease
Postoperative diagnosis: Same
Anesthesia: General
Procedure: The patient was brought to the operating room and placed in the supine position. With the patient under general intubation anesthesia, the anterior chest, abdomen and legs were prepped and draped in the usual fashion. Review of a postoperative angiography showed severe, recurrent, two-vessel disease with normal ventricular function. A segment o the femoropopliteal artery was harvested using endoscopic vein- harvesting technique and prepared for grafting. The patient was heparinized and placed on cardiopulmonary bypass. The patient was cooled as necessary for the remainder of the procedure and an aortic cross-clamp was placed. The harvested vein was anastomosed to the aorta and brought down to circumflex and anastomosed into place. An artery was anastomosed to the left subclavian artery and brought down to the left anterior descending and anastomosed into place. The aortic cross-clamp was removed after 55 minutes with spontaneous cardio version to a normal sinus rhythm. The patient was warmed and weaned from the bypass without difficulties after 104 minutes. The patient achieved homeostasis. The chest was drained and closed inlayers in the usual fashion. The leg was closed in the usual fashion. Sterile dressings were applied and the patient returned to intensive care recovery in satisfactory condition.
How should Dr. Manning report is services for Monday and Tuesday in this case?
a) Monday: 99255-57; Tuesday: 33511, 33517, 35600
b) Monday: 99215-57; Tuesday: 33533, 33517-57, 35572-80, 33530-51
c) Monday: 99255-57; Tuesday: 33533, 33510, 33572, 33530
d) Monday: 99215-57; Tuesday: 33533, 33517, 35572, 33530