Deaconess Posted Fri 14th of October, 2016 17:01:56 PM
Hi, would 37824-LT be the only code reported for this procedure?
procedure performed: modified radical neck dissection with removal of levels 1a, 1b on the left, 2a on the left, and level 3 on the left.
the patient was taken to the operating room, placed supine on the bed. General endotracheal anesthesia was induced without complication. Incision approximately 2 cm below the angle of the mandible was marked out and injected with 1% lidocaine and epinephrine. The skin was then incised with a 15-blade scalpel down through the subcutaneous tissue until the platysma was identified. This transverse incision was approximately 8 cm in length. Subplatysmal flaps were elevated up to the angle of the mandible and down to the level of the clavicle. We began with a level 1a dissection beginning at the mentum. The fibrofatty contents of 1a was dissected off of the mylohyoid with care to get adequate hemostasis as the specimen was peeled off of the mylohyoid. Oce we were under the specimen where the mass was, it was densely adherent and a cuff of mylohyoid tissue was taken to ensure an adequate margin. The specimen was then peeled off the contralateral digastric and the hyaloid and reflected into the surgical field laterally on the left and then amputated and sent off as level 1a. We then began our level 1b dissection. The marginal branch of the facial nerve was identified in the fascia just overlying the facial vessels. It was dissected posteriorly and anteriorly, and the facial vessels were then ligated allowing it to be reflected superiorly. Once this was done the fibrofatty contents running anteriorly were dissected in a spraperiosteal plane allowing the fibrofatty contents to be reflected off of the mylohyoid. Once this was done inferior traction was then held to pull the submandibular gland down out of level 1a, visualizing the lingual nerve as well as the hypoglossal nerve. Once these 2 structures were seen the submandibular duct was ligated with suture. Continuing to reflect the contents inferiorly the submandibular ganglion was transected and the proximal portion of the facial artery was also suture ligated. This then reflected all the contents inferiorly down to the posterior belly of the digastric, and this was sent off as level 1b. We then began our dissection of level 2a and 3. The fibrofatty contents were divided overlying the digastric muscle, and this was treated posteriorly to the SCM. The fibrofatty contents and fascial envelope of the SCM was then opened medially until we were down to the level of the tendon of the omohyoid. At this point the dissection proceeded medially identifying the cervical rootlets at which point our dissection turned medially onto the floor of the neck. Care was taken to preserve as many cervical rootlets as possible. Prior to turning the dissection medially in level 2, the spinal accessory nerve was identified and traced proximally up the level of the digastric. Care was taken with careful hemostasis we continued to reflect the fibrofatty contents off the floor of the neck, and once the ansa was identified, transitioned to more superficial plane overlying the jugular vein. Beginning inferiorly and moving superiorly, the ansa was followed, and the fibrofatty contents was reflected off the jug. The facial vein was also suture ligated. Once we were at the level of the ranine veins, inferior to the digastric, the hypoglossal nerve was traced proximally to ensure that it was not inadvertently ligated when the specimen was amputated. Once the specimen was amputated, it was divided into level 2a and 3. The wound was copiously irrigated, and Valsalva was held to confirm that there is no evidence of chyle leak inferiorly in the dissection bed and that there was adequate hemostasis.
SuperCoder Answered Mon 17th of October, 2016 07:16:10 AM