PREOPERATIVE DIAGNOSIS: Large hematoma/seroma in the left antecubital
fossa close to the brachial artery to graft anastomosis.
POSTOPERATIVE DIAGNOSIS: Seroma.
PROCEDURES: Exploration of left upper arm arteriovenous shunt graft and
evacuation of seroma.
STATEMENT OF MEDICAL NECESSITY:an 81-year-old female
with end-stage renal disease on hemodialysis. The patient has a left
upper arm arteriovenous shunt graft between her brachial artery and
axillary vein in her left upper arm. That was done in June of this
year. She was admitted to the hospital this morning where she presented
with a large pulsatile mass in her antecubital fossa close to the
brachial artery anastomosis. She had ulcerated skin over it from the
pressure and draining clear fluid. Patient stated that it was draining
some blood but never had a significant hemorrhage from it. On
examination, it appeared that the pulsation we could feel was just
reflection from the graft, however, due to her proximity to the arterial
anastomosis and the condition of the skin, we felt that emergent
exploration is warranted. I explained to the patient that we are going
to put a tourniquet in case we encounter significant hemorrhage.
Patient understood the risks of the procedure. Formal consent was
obtained.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room,
placed upon the operating table. General anesthesia was administered
successfully. Left upper extremity was prepared and draped in the usual
sterile fashion. A tourniquet was placed in the left axilla and was
prepared but was not inflated yet. First, using a 20-gauge syringe, we
aspirated through healthy skin and we encountered just what appeared to
be seroma. Culture was sent. At this time, the ulcerated skin was
explored and immediately a gush of a large amount of yellow fluid was
evacuated. No bleeding was encountered, therefore, we did not employ
the tourniquet. At this time, a small retractor was placed into the
opening and we explored the cavity. The graft was not exposed, in fact
is incorporated, and we felt that there is no sign of gross infection
and we do not need to do anything at this time. The area was debrided
and then closed partially using 1 stitch of 4-0 Prolene. We kept the
wound partially open so it continued to drain. A pressure dressing was
placed and the patient tolerated the procedure well, transferred to
recovery room in stable condition. Patient remained to have a palpable
thrill in her graft as well as her left forearm. I was present for the
entire procedure.
What codes would you put on this?? 35761 for the exploration, and 10140???
fossa close to the brachial artery to graft anastomosis.
POSTOPERATIVE DIAGNOSIS: Seroma.
PROCEDURES: Exploration of left upper arm arteriovenous shunt graft and
evacuation of seroma.
STATEMENT OF MEDICAL NECESSITY:an 81-year-old female
with end-stage renal disease on hemodialysis. The patient has a left
upper arm arteriovenous shunt graft between her brachial artery and
axillary vein in her left upper arm. That was done in June of this
year. She was admitted to the hospital this morning where she presented
with a large pulsatile mass in her antecubital fossa close to the
brachial artery anastomosis. She had ulcerated skin over it from the
pressure and draining clear fluid. Patient stated that it was draining
some blood but never had a significant hemorrhage from it. On
examination, it appeared that the pulsation we could feel was just
reflection from the graft, however, due to her proximity to the arterial
anastomosis and the condition of the skin, we felt that emergent
exploration is warranted. I explained to the patient that we are going
to put a tourniquet in case we encounter significant hemorrhage.
Patient understood the risks of the procedure. Formal consent was
obtained.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room,
placed upon the operating table. General anesthesia was administered
successfully. Left upper extremity was prepared and draped in the usual
sterile fashion. A tourniquet was placed in the left axilla and was
prepared but was not inflated yet. First, using a 20-gauge syringe, we
aspirated through healthy skin and we encountered just what appeared to
be seroma. Culture was sent. At this time, the ulcerated skin was
explored and immediately a gush of a large amount of yellow fluid was
evacuated. No bleeding was encountered, therefore, we did not employ
the tourniquet. At this time, a small retractor was placed into the
opening and we explored the cavity. The graft was not exposed, in fact
is incorporated, and we felt that there is no sign of gross infection
and we do not need to do anything at this time. The area was debrided
and then closed partially using 1 stitch of 4-0 Prolene. We kept the
wound partially open so it continued to drain. A pressure dressing was
placed and the patient tolerated the procedure well, transferred to
recovery room in stable condition. Patient remained to have a palpable
thrill in her graft as well as her left forearm. I was present for the
entire procedure.
What codes would you put on this?? 35761 for the exploration, and 10140???
Exploration of AVF, and evac of seroma
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