Kelly Posted Sat 29th of October, 2016 09:24:40 AM
How would the following report be coded:
PREOPERATIVE DIAGNOSIS: Infected left axillary artery femoral vein graft.
POSTOPERATIVE DIAGNOSIS: Infected left axillary artery femoral vein graft.
PROCEDURE: Wound exploration, debridement of skin, subcu and fascia. Excision of AV
graft, placement of wound VAC x2.
PROCEDURE: The patient was placed in the supine position. His left neck, chest, abdomen
and groin were prepped and draped following the induction of general anesthesia. A wound in
the left lower quadrant of the abdomen was debrided. The graft was clearly exposed. There
was pus along the track of the graft as well as erythema, extending over the involved portion of
the graft. The erythema extended from the groin to the patient's left axilla. The second
incision was made over a well-healed left chest counter incision and there was pus tracking
along the graft at this level. The pus appeared to extend several centimeters more proximal.
The graft was divided proximally and distally and removed. The graft was removed in its
entirety from the left chest wall incision down to the femoral vein. No bleeding was encountered
from the femoral vein. All devitalized and infected tissues were debrided with sharp dissection
as well as with cautery. The groin wound was saucerized mildly. The groin wound and graft
track were irrigated with 2 liters of saline containing Keflex. The wounds were irrigated until the
irrigation was quite clear. It should be noted that a third incision was made directly over the
graft which was localized by ultrasound in the axilla. The graft was clamped, divided, suture
ligated with a 3-0 Prolene proximally and this section of the graft was removed as well. This
portio of the track was irrigated. The subcutaneous tissues at this level at the most proximal
incision in the left axilla were closed with a 3-0 Vicryl suture and the skin was closed with a
running 4-0 Monocryl subcuticular suture. The remaining 2 wounds were then packed with a
black sponge and connected using a Y connector to a wound VAC once hemostasis was
insured. Swabs of the pus as well as a portion of graft were sent for culture.
SuperCoder Answered Tue 01st of November, 2016 03:10:18 AM