Mary Posted Fri 01st of August, 2014 15:30:58 PM
Patient is a 36 yo female ventilator patient seen at another facility where trach dislodgement occurred. This is where initial trach was done. After admission to our nursing home, she was brought to our OR and local anesthesia with 1% xylocaine was infiltrated in previous trach site for extension and reopening of incision was accomplished with 15 bladed scalpel. Dissection of the previous trach site revealed a lot of granulation tissue that was removed. Patient, who is obese, had a deep lying trachea. After having tediously and purposely dissecting the previous trach site, the anterior part of the trachea was identified, and it appeared to be nondisturbed from any prior trach insertion. An incision was made vertically in the trach where the previous indwelling anesthetic endotracheal tube was noted. Site was spread with a Kelly clamp very carefully and trach tube spread very carefully. At this point a #8 Shiley trach tube was inserted without difficulty. Due to patient's thick neck, tube was literally stuck down onto tissues and could not undergo dressing replacement and the like. Because of this , it was decided to remove this tube and insert an extended length trach tube. A #8 extended length trach tube was identified and brought to OR where this smiley tracheostomy tube was inserted and the extended length through her ribs was reinserted but was noted not to be in good position. Tube was removed and reinserted two to three times without any good returns. The short smiley trach tube was inserted and there was no return of air and exchange of gases. Because of this, bronchoscope was prepared and extent was passed down thru endotracheal tube revealing what appeared to be a small trachea. Also noted was a laceration on what appears to be on the left posterolateral wall of the trachea a few cm above the carina. At this point, it was decided to reinsert the extended trach tube. this was accomplished by using an endotracheal obturator that was lubricated and slid through trach site down along the current endotracheal tube in place. Obturator was verified to be in right mainstem bronchus whereupon the extended length trach tube was passed over this obturator to be placed in good position. This was accomplished after endotracheal tube was pulled back into laryngeal area above trach stoma. Bronchoscope was then reintroduced through the placed extended length trach tube revealing it to be in good position after obturator had been removed. Balloon was then inflated and tube was secured in the usual manner after closure with a lateral incision in the neck using 3-0 chromic suture on the epidermis.
I am totally confused and would appreciate any help!
SuperCoder Answered Mon 04th of August, 2014 03:59:09 AM
You should use the unlisted code 31899 for the above procedure, there is no other code that matches with the above procedure.
31899 represents 'Unlisted procedure, trachea, bronchi'.