PROCEDURAL NOTE
PATIENT: Lopez, Olga
AGE: 76 years
DATE: 11/05/2014
PATIENT DIAGNOSIS: Multiple skull lymphomas
PROCEDURE: Craniotomy converted to craniectomy of left anterior cranial base
ANESTHESIA: General endotracheal
The patient was placed in supine position on operating table and anesthesia was successfully administered. The patient was then prepped in the usual manner. An incision was made on the midline of the patient’s anterior cranial base and the surgeon dissected the epidermal layer to reveal the skull. Three .2 to .4cm lymphomas were then located and the skull bone was excised in one piece to remove the affected areas, leaving .1cm margins. Halfway through the procedure the patient’s blood pressure dropped, which was difficult to control for the remainder of the procedure. Due to the patient’s drop in blood pressure, the surgeon decided to convert the procedure to a craniectomy, therefore bone grafts were not placed. A drain was placed beneath the remaining skull base and the edges of the skin were then sutured back together using 4-0 vicryl sutures. A sterile dressing was placed on the excision site. The patient was then removed from endotracheal anesthesia and remained under physician supervision until her blood pressure stabilized. She was then taken to the recovery room and scheduled for a bone graft at a later date.
Explanation
Answer: C - The correct codes are 00192 (Anesthesia for procedures on facial bones or skull; radical surgery), 99135, (Anesthesia complicated by utilization of controlled hypotension), and 99100, (Anesthesia for patient of extreme age, younger than 1 year or older than 70). 00211 (Anesthesia for intracranial procedures; craniotomy or craniectomy for evacuation of hematoma) is not appropriate, in this case, because the craniectomy was not performed as a result of a hematoma. Also, because both qualifying circumstances codes apply, both of them must be appended to the anesthesia code.
