this is my coding on this op report. Any other suggested codes, or am I correct?
35903,11981,15378,97608
Operative Report Date of service:: 05/12/21
Operative Report:: Proposed Procedure: Right groin hematoma exploration
Performed Procedure:
1. Retroperitoneal exposure of R EIA
2. Excision of R CFA PTFE bypass with patch angioplasty with dacron patch 35903
3. Absorbable antibiotic bead placement 11981
4. Pedicled vascularized rotational sartorious flap 15738
5. Negative pressure dressing, with measurements 10 cm x 4 cm x 3 cm 90608
Pre-Operative Diagnosis: Right groin hematoms
Post-Operative Diagnosis: Right groin patch infection with anastamotic breakdown
None Estimated Blood Loss: 400 cc Specimens Removed: cultures and right groin PTFE and bovine pericardial patch for culture
Findings: thrombosed bypass with breakdown of the bovine pericardial patch, good PFA backbleeding
Operative Report: The patient and family were met in holding the risks and complications of the procedure were discussed with the patient to include but not limited to pain, bleeding, infection, damage to surrounding structures, embolization, amputation,
failure of bypass, infection , heart attack, stroke and death. The patient signed the consent and was then taken to the OR and underwent GETA and line placement. The patient was then prepped and draped in the usual sterile fashion. A time out was performed confirming the procedure and laterality as well as perioperative antibiotics. We opened the prior wound along the hematoma and evacuated the hematoma, we noted there was bleeding along the patch and graft anastamaotic conection. We controlled this with digital pressure. We then made an oblique incision above the inguinal ligament and used electrocautery to dissect out the anterior fascia. We then used the cautery to transect the external oblique, internal oblique and transfersalis fascia. We then took care not to enter the peritoneum and any hole in the peritoneum was repaired with a vicryl suture. We then used blunt dissection to rotate the retroperitionem from cc: BHUPINDER S SANGHA MD; BOBBY C BROCK; SARAH ELIZABETH LESTER MD; ZACK NASH MD Guadalupe Regional Medical Ctr 1215 East Court Street Seguin, TX 78155 Operative Note GVH 2 Patient name: Difonzo,Daniel Francis Report #: 0512-00290 Account #: V00003129918 lateral to medial and we identified the psoas and medial to the psoas we dissected out the EIA, we placed a vessel loop around the EIA for control. The patient was heparinized with ACT goals > 200. We then clamped the vessel and had inflow control. We then controlled any bleeding with a 6-O prolone along the graft. We then dissected out the CFA and PFA, noting very dense scar tissue. We were able to clamp the PFA and SFA in the AP orientation and control the PFA. To aid in dissection the bypass was transected and oversewn in both ends. We then dissected proximally adequate length to allow for a healthy end point. We excised the old PTFE anastamosis and we then used a 6F fogarty to control antegrade bleeding. We then sewed in a dacron patch with 6-O Prolene in a running fashion and prior to completion we removed the fogarty. We noted good backbleeding and antegrade bleeding prior to completing the repair. We then extended our incision lateraly and mobilized the sartorius takinc care not to devascularize the muscle. We took the muscle down from the ASIS. We then pulse lavaged the wound with copious irrigation. Once complete we ensured excellent hemostasis. We then placed vacomycin and tobramycin infused beads overtop the vessel below. We then tacked down the sartorious rotational flap superiory, medially and inferiorly noting no tension on the muscle overtop the beads. We then tailored a sponge and occlusive dressing for the negative pressure dressing. We then ensured excellent hemostatiss in the retropertonium and we then closed the posterior fascia with a O PDS and the anterior fascia with an O PDS. We then closed the deep layers with a 3-O PDS and the skin with a 4-O monocryl in a subcuticular manner. We then applied a negative pressure dressing. The patient tolerated the procedure and was awoken, extubated and transferred to ICU in stable condition.
35903,11981,15378,97608
Operative Report Date of service:: 05/12/21
Operative Report:: Proposed Procedure: Right groin hematoma exploration
Performed Procedure:
1. Retroperitoneal exposure of R EIA
2. Excision of R CFA PTFE bypass with patch angioplasty with dacron patch 35903
3. Absorbable antibiotic bead placement 11981
4. Pedicled vascularized rotational sartorious flap 15738
5. Negative pressure dressing, with measurements 10 cm x 4 cm x 3 cm 90608
Pre-Operative Diagnosis: Right groin hematoms
Post-Operative Diagnosis: Right groin patch infection with anastamotic breakdown
None Estimated Blood Loss: 400 cc Specimens Removed: cultures and right groin PTFE and bovine pericardial patch for culture
Findings: thrombosed bypass with breakdown of the bovine pericardial patch, good PFA backbleeding
Operative Report: The patient and family were met in holding the risks and complications of the procedure were discussed with the patient to include but not limited to pain, bleeding, infection, damage to surrounding structures, embolization, amputation,
failure of bypass, infection , heart attack, stroke and death. The patient signed the consent and was then taken to the OR and underwent GETA and line placement. The patient was then prepped and draped in the usual sterile fashion. A time out was performed confirming the procedure and laterality as well as perioperative antibiotics. We opened the prior wound along the hematoma and evacuated the hematoma, we noted there was bleeding along the patch and graft anastamaotic conection. We controlled this with digital pressure. We then made an oblique incision above the inguinal ligament and used electrocautery to dissect out the anterior fascia. We then used the cautery to transect the external oblique, internal oblique and transfersalis fascia. We then took care not to enter the peritoneum and any hole in the peritoneum was repaired with a vicryl suture. We then used blunt dissection to rotate the retroperitionem from cc: BHUPINDER S SANGHA MD; BOBBY C BROCK; SARAH ELIZABETH LESTER MD; ZACK NASH MD Guadalupe Regional Medical Ctr 1215 East Court Street Seguin, TX 78155 Operative Note GVH 2 Patient name: Difonzo,Daniel Francis Report #: 0512-00290 Account #: V00003129918 lateral to medial and we identified the psoas and medial to the psoas we dissected out the EIA, we placed a vessel loop around the EIA for control. The patient was heparinized with ACT goals > 200. We then clamped the vessel and had inflow control. We then controlled any bleeding with a 6-O prolone along the graft. We then dissected out the CFA and PFA, noting very dense scar tissue. We were able to clamp the PFA and SFA in the AP orientation and control the PFA. To aid in dissection the bypass was transected and oversewn in both ends. We then dissected proximally adequate length to allow for a healthy end point. We excised the old PTFE anastamosis and we then used a 6F fogarty to control antegrade bleeding. We then sewed in a dacron patch with 6-O Prolene in a running fashion and prior to completion we removed the fogarty. We noted good backbleeding and antegrade bleeding prior to completing the repair. We then extended our incision lateraly and mobilized the sartorius takinc care not to devascularize the muscle. We took the muscle down from the ASIS. We then pulse lavaged the wound with copious irrigation. Once complete we ensured excellent hemostasis. We then placed vacomycin and tobramycin infused beads overtop the vessel below. We then tacked down the sartorious rotational flap superiory, medially and inferiorly noting no tension on the muscle overtop the beads. We then tailored a sponge and occlusive dressing for the negative pressure dressing. We then ensured excellent hemostatiss in the retropertonium and we then closed the posterior fascia with a O PDS and the anterior fascia with an O PDS. We then closed the deep layers with a 3-O PDS and the skin with a 4-O monocryl in a subcuticular manner. We then applied a negative pressure dressing. The patient tolerated the procedure and was awoken, extubated and transferred to ICU in stable condition.
