Chapter 4 Workbook Code Building Exercises

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Medicine

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Apr 3, 2024

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Chapter 4 Workbook Code Building Exercises Question 1 (Reposition) DIAGNOSIS: Nasal septal deviation, bilateral inferior turbinate hypertrophy PROCEDURE PERFORMED: Nasal septal reconstruction, bilateral coblation of the inferior turbinates FINDINGS: Upon inspecting the nose, the patient has bilateral deviations with an anterior bowing of the septum to the right and posterior bowing to the left. Enlarged turbinates. DESCRIPTION OF PROCEDURE: With the patient in the supine position, the head and body were draped in the usual fashion. The nose was decongested using topical Afrin on cottonoids, as well as injections of 1% Xylocaine with epinephrine. A left-sided mucoperichondrial flap was raised. Attention was then turned to the maxillary crest which was broad and deviated. The periosteum was raised bilaterally and relaxing cuts were made from the left side of the cartilage at the posterior and anterior. One central relaxing cut was made from the right side. The cartilage was relaxed into the midline and was then fixed in the midline using two transfixion sutures of 3-0 chromic. The incision was closed using 5-0 chromic and the mucoperichondrial flaps were reapproximated using a running mattress stitch of 4-0 plain gut. Attention was then turned to the inferior turbinates. Using the nasal wand for the Coblator, two passes were made into each turbinate, one superior and one inferior. Two to three areas of coblation were performed with each pass at a setting of 4, each for 8–10 seconds. The nose was packed using folded Telfa gauze with bacitracin. A stitch of 3-0 silk was used anteriorly to support the packing. The patient tolerated this well and was transferred to the recovery room, extubated in stable condition. 1.1. What is the intent of the procedure performed on the nasal septum? To straighten the nasal septum to the middle for better air flow 1.2. What is the objective of the procedure performed on the nasal turbinates? To reduce the size 1.3. What clues are found within the report to help identify the approaches used in these procedures? Mucoperichondrial flap was raised. periosteum was raised bilaterally and relaxing cuts were made, and using the nasal wand 1.4. What code(s) should be assigned? 09SM0ZZ, 095L3ZZ Question 2 ( Release) DIAGNOSIS : Trigger finger, tenosynovitis and pain, left long finger PROCEDURE : Release with neurolysis of median digital nerve DESCRIPTION : With the patient in the dorsal supine position and under adequate anesthesia, the entire left upper extremity was prepped and draped. The left upper extremity was exsanguinated with Esmarch and a tourniquet was inflated to 250 mmHg at the proximal left arm. Attention was then directed to the left long finger. On the palmar aspect, a Brunner incision was made and opened in Z flap fashion. The subcutaneous tissue and fascia were incised. The palmar digital branch of the median nerve was identified, neurolysed, and retracted away from harm. The A-1 pulley was located and incised both proximally and distally, liberating the trigger of the flexor digitorum superficialis tendon of the left long finger. The tourniquet was released. Bleeders were clamped and coagulated.
The wound was infiltrated with 0.5% Sensorcaine at the palmar incision. The subcutaneous tissue was closed with 4-0 Vicryl and the skin with staples. The wound was dressed and a volar dorsal splint was put into position. 2.1. Research the neurolysis procedure. What is the intent of this procedure? Neurolysis refers to the procedure of ‘freeing up’ a nerve surgically.   2.2. Where does the body part key classify the flexor digitorum superficialis tendon? There is no entry 2.3. What is the next step? Perform a google search/ anatomy reference 2.4. Where is this tendon classified? Hand 2.5. What code(s) should be assigned? 01N50ZZ , 0LN80ZZ
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