THE CODING EDGE® ARCHIVES

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Coding Recommendations - Feature Article 10/15/98
   

Procedure Practice
    

Using ICD-9-CM and CPT-4, assign codes for the procedure(s) described in this "real-life" patient report.

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Patient: Doe, Mary

Diagnosis: Rhegmatogenous retinal detachment, right eye

Procedure: Scleral buckle repair, right eye

Indications for Procedure: The patient is a 62-year-old female who has recently noted markedly failing vision in her right eye. She underwent right eye scleral buckling nine months ago for a prior retinal detachment. Fluorescein angiography again reveals retinal detachment and the patient is admitted at this time for repeat repair.

Description of Procedure: The patient was taken to the Operating Room and placed supine on the table. General anesthesia was administered and the patient was prepped and draped in the usual sterile fashion. A lid speculum was inserted into the right eye and a peritomy was done from the 3 o’clock to the 8 o’clock position with small relaxing incisions at the extremes. A curved Stevens was used to enter the inferotemporal and infranasal quadrants. The band from the previous buckle was encased in scar tissue and this was released. The anchor suture was removed and the band rotated to move the sleeve from the inferotemporal quadrant to the inferonasal quadrant.

The rectus muscles were secured with bridle sutures and indirect ophthalmoscopy was done to isolate the retinal tears. One tear was located at 3 o’clock and a second tear was noted in the 5 o’clock position.

At this point the cryoprobe was inserted and applied circumferentially around the holes and the sclera was marked for placement of the buckle. A #507 sponge was placed in Garamycin solution. Thie was measured and cut after placing two 5-0 Dacron sutures in the infratemporal quadrant and one in the infranasal quadrant. The sponge was slipped under the 240 band and temporarily tied with 5-0 Dacron. The retina was examined and noted to be well-supported on the sponge. It was very difficult to get the sponge under the lateral rectus muscle because of the location of the prior scleral buckle element. The temporary sutures were converted to permanent sutures and the IOP was checked with the Schiotz and found to be 40 mm. Hg. Indirect ophthalmoscopy revealed the optic nerve to be well-perfused at this pressure.

With the optic nerve adequately perfused and the retina well-supported by the new buckle, the bridle sutures were removed and the anchor suture in the inferonasal quadrant was secured to hold the band in place. The conjunctiva was closed with interrupted 8-0 Vicryl sutures. The bed of the scleral buckle was irrigated with Garamycin, and a solution of Garamycin and Celestone was injected into the subconjunctival space. Tobradex ointment and a sterile patch with plastic eye shield were applied to the eye.

The patient tolerated the procedure well and was taken to the Recovery Room in satisfactory condition.

   

     

Using the above samples, do your own coding and then compare it with our recommendations.

Notice: This part of our web site was prepared to assist in understanding and maintaining good coding skills. For proper use of this feature, reference must be made to official coding guidelines when necessary. The information here presented is only to be used as a supplement to those guidelines. Laguna Medical Systems, Inc., makes no representations or guarantees as to amounts that will be paid by Medicare or other third party payers.

 

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to reflect possible coding rules and regulation changes made after the publishing date.