Reference no: EM133244778

Assignment:

The patient was brought to the operating room in the supine position after induction of general endotracheal anesthesia. The head was placed in a gel donut on a horseshoe. Frontal areas were shaved, prepped and draped in standard sterile fashion using a Loban drape. A long line of incision was marked bilaterally in the frontal region and infiltrated with 1/2 percent lidocaine with 1:200,000 epinephrine. The skin incision was made in the frontal region down to the pericranium. Subperiosteal dissection was carried out. A burr hole was created and a craniectomy was extended. The dura was opened and the dural leaflets were obtained. Subdural space was copiously irrigated with normal saline until the egress was clear.

A 35-cm ventriculostomy catheter was brought into the field and inserted into the subdural space without difficulty. This was now brought out through the original burr hole, tunneled under the skin and brought out of the skin through a separate incision. This was then secured to the skin and connected to an externalized drainage bag. Attention was directed to reconstruction of the cranial opening. The reconstruction was carried out using the Lorenz plating system and titanium microscrews for cranioplasty. The wound was irrigated and closed in the usual fashion using 2-0 Vicryl for the deeper layers and staples for the skin. Sterile dressings were applied.

Questions:

1. Which root operation is assigned for the evacuation of the subdural hematoma?

2. Is a separate code assigned for the externalized shunt?

3. Is a separate code assigned for the craniectomy?

4. A Lorenz plating system and titanium microscrews are used to perform a cranioplasty. Is a code for the insertion of an internal fixation device into the skull assigned for this case?

5. What code(s) should be assigned.