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Diagnostic Direct Laryngoscopy, Bronchoscopy & Esophagoscopy
Post-Operative Instruction Sheet Diagnostic Direct Laryngoscopy, Bronchoscopy & Esophagoscopy Direct Laryngoscopy: Examination of the voice box or larynx (pronounced “lair-inks”) under general anesthesia. An instrument called a laryngoscope is carefully placed into the mouth and used to visualize the larynx and surrounding structures. Bronchoscopy: Examination of the windpipe below the voice box in the neck and chest under general anesthesia. A long narrow telescope is passed through the larynx and used to carefully inspect the structures of the trachea and bronchi. Esophagoscopy: Examination of the swallowing pipe in the neck and chest under general anesthesia. An instrument called an esophagoscope is passed into the esophagus (just behind the larynx and trachea) and used to visualize the mucus membranes and surrounding structures of the esophagus. Frequently a small biopsy is taken to evaluate for signs of esophageal inflammation (esophagitis). What to Expect: Diagnostic airway endoscopy procedures generally take about 45 minutes to complete. Usually the procedure is well-tolerated and the child is back-to-normal the next day. Mild throat or tongue discomfort may persist for a few days after the procedure and is usually well-controlled with over-the-counter acetaminophen (Tylenol) or ibuprofen (Motrin). Warning Signs: Contact the office immediately at (603) 650-4399 if any of the following develop: • Worsening harsh, high-pitched noisy-breathing (stridor) • Labored breathing with chest retractions or flaring of the nostrils • Bluish discoloration of the lips or fingernails (cyanosis) • Persistent fever above 102°F that does not respond to Tylenol or Motrin • Excessive coughing or respiratory distress during feeding • Coughing or throwing up bright red blood • Excessive drowsiness or unresponsiveness Diet: Resume baseline diet (no special postoperative diet restrictions). -
Once in a Lifetime Procedures Code List 2019 Effective: 11/14/2010
Policy Name: Once in a Lifetime Procedures Once in a Lifetime Procedures Code List 2019 Effective: 11/14/2010 Family Rhinectomy Code Description 30160 Rhinectomy; total Family Laryngectomy Code Description 31360 Laryngectomy; total, without radical neck dissection 31365 Laryngectomy; total, with radical neck dissection Family Pneumonectomy Code Description 32440 Removal of lung, pneumonectomy; Removal of lung, pneumonectomy; with resection of segment of trachea followed by 32442 broncho-tracheal anastomosis (sleeve pneumonectomy) 32445 Removal of lung, pneumonectomy; extrapleural Family Splenectomy Code Description 38100 Splenectomy; total (separate procedure) Splenectomy; total, en bloc for extensive disease, in conjunction with other procedure (List 38102 in addition to code for primary procedure) Family Glossectomy Code Description Glossectomy; complete or total, with or without tracheostomy, without radical neck 41140 dissection Glossectomy; complete or total, with or without tracheostomy, with unilateral radical neck 41145 dissection Family Uvulectomy Code Description 42140 Uvulectomy, excision of uvula Family Gastrectomy Code Description 43620 Gastrectomy, total; with esophagoenterostomy 43621 Gastrectomy, total; with Roux-en-Y reconstruction 43622 Gastrectomy, total; with formation of intestinal pouch, any type Family Colectomy Code Description 44150 Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy 44151 Colectomy, total, abdominal, without proctectomy; with continent ileostomy 44155 Colectomy, -
A Clinical Prediction Rule for Pulmonary Complications After Thoracic Surgery for Primary Lung Cancer
A Clinical Prediction Rule for Pulmonary Complications After Thoracic Surgery for Primary Lung Cancer David Amar, MD,* Daisy Munoz, MD,* Weiji Shi, MS,† Hao Zhang, MD,* and Howard T. Thaler, PhD† BACKGROUND: There is controversy surrounding the value of the predicted postoperative diffusing capacity of lung for carbon monoxide (DLCOppo) in comparison to the forced expired volume in 1 s for prediction of pulmonary complications (PCs) after thoracic surgery. METHODS: Using a prospective database, we performed an analysis of 956 patients who had resection for lung cancer at a single institution. PC was defined as the occurrence of any of the following: atelectasis, pneumonia, pulmonary embolism, respiratory failure, and need for supplemental oxygen at hospital discharge. RESULTS: PCs occurred in 121 of 956 patients (12.7%). Preoperative chemotherapy (odds ratio 1.64, 95% confidence interval 1.06–2.55, P ϭ 0.02, point score 2) and a lower DLCOppo (odds ratio per each 5% decrement 1.13, 95% confidence interval 1.06–1.19, P Ͻ 0.0001, point score 1 per each 5% decrement of DLCOppo less than 100%) were independent risk factors for PCs. We defined 3 overall risk categories for PCs: low Յ10 points, 39 of 448 patients (9%); intermediate 11–13 points, 37 of 256 patients (14%); and high Ն14 points, 42 of 159 patients (26%). The median (range) length of hospital stay was significantly greater for patients who developed PCs than for those who did not: 12 (3–113) days vs 6 (2–39) days, P Ͻ 0.0001, respectively. Similarly, 30-day mortality was significantly more frequent for patients who developed PCs than for those who did not: 16 of 121 (13.2%) vs 6 of 835 (0.7%), P Ͻ 0.0001. -
Airway Versus Transbronchial Biopsy and BAL in Lung Transplant Recipients: Different but Complementary
Eur Respir J 1997; 10: 2876–2880 Copyright ERS Journals Ltd 1997 DOI: 10.1183/09031936.97.10122876 European Respiratory Journal Printed in UK - all rights reserved ISSN 0903 - 1936 Airway versus transbronchial biopsy and BAL in lung transplant recipients: different but complementary C. Ward, G.I. Snell, B. Orsida, L. Zheng, T.J. Williams, E.H. Walters Airway versus transbronchial biopsy and BAL in lung transplant recipients: different Dept of Respiratory Medicine, Alfred but complementary. C. Ward, G.I. Snell, B. Orsida, L. Zheng, T.J. Williams, E.H. Walters. Hospital and Monash University Medical ©ERS Journals Ltd 1997. School, Melbourne, Australia. ABSTRACT: Lung transplantation is now an established therapeutic intervention Correspondence: E.H Walters for end-stage cardiopulmonary disease in humans. Chronic rejection, in the form Dept of Respiratory Medicine of bronchiolitis obliterans syndrome (BOS), remains the commonest cause of mor- Alfred Hospital bidity and mortality in those surviving more than 3 months. The pathology of BOS Prahran involves airway changes. We have evaluated the potential for endobronchial biop- Melbourne sies (EBB) to complement existing sampling methods used in allograft monitoring Victoria 3181 and have compared the results of EBB findings with those of bronchoalveolar Australia lavage (BAL) and transbronchial biopsy (TBB) in 18 clinically stable patients. Keywords: Bronchoalveolar lavage We found that all the EBB had inflammatory cells present but that only five endobronchial biopsy TBB specimens had evidence of inflammation, with airway material being present lung transplant in 78% of the TBB. Paired BAL and EBB yielded different results, with no cor- transbronchial biopsy relations between total macrophages, lymphocytes, CD4+ cells or CD8+ cells. -
A Late Complication of a Diagnostic Mediastinoscopy
Thorax: first published as 10.1136/thx.33.1.115 on 1 February 1978. Downloaded from Thorax, 1978, 33, 115-116 A late complication of a diagnostic mediastinoscopy H. F. W. HOITSMA1, E. T. T. TJHO2, AND M. A. CUESTA' From the Departments of General Surgery' and Thoracic Medicine2, Het Academisch Ziekenhuis der Vrije Universiteit, Amsterdam, The Netherlands Hoitsma, H. F. W., Tjho, E. T. T., and Cuesta, M. A. (1978). Thorax, 33, 115-116. A late complication of a diagnostic mediastinoscopy. A 69-year-old man with a moderately well differentiated squamous-cell carcinoma of the lung, underwent a mediastinoscopy. All histological examinations of the mediastinal nodes were negative. The patient was treated with a curative left pneumonectomy. Three months after this negative mediastinoscopy the patient developed a metastasis in the mediastinoscopy scar. A report of this case and a review of the literature are presented. In 1959, Carlens wrote the article, which has since all of them at biopsy. Histological investigation of become famous, entitled 'Mediastinoscopy: a the biopsy specimens showed fragmented and com- method for inspection and tissue biopsy in the plete lymph nodes with an intact structure. Besides superior mediastinum'. He described a method anthracotic infiltration there was a firm, histiocytic which he had developed in order to assess the reaction. No tumour cells were found. copyright. stage of lymphatic metastasis of carcinoma of the Ten days later the patient underwent a left lung. Since its introduction it has become a much pneumonectomy. All visible nodes in the hilus and used method to avoid unnecessary thoracotomies. -
Coding Billing
Coding&Billing Quarterly JANUARY 2018 Welcome to the January issue of the ATS Coding and Billing Quarterly. This issue covers a lot of new Medicare EDITOR payment policies that will impact ATS members and their ALAN L. PLUMMER, MD ATS RUC Advisor practices starting Jan. 1, 2018. ADVISORY BOARD MEMBERS: Medicare released the final rules for both the 2018 Medicare KEVIN KOVITZ, MD Chair, ATS Clinical Practice Committee Physician Fee Schedule – which covers payment and coverage KATINA NICOLACAKIS, MD policies for physicians and other Medicare Part B providers Member, ATS Clinical Practice Committee – and the Medicare Hospital Outpatient Prospective ATS Alternate RUC Advisorr Payment Rule – which deals with reimbursement STEPHEN P. HOFFMANN, MD Member, ATS Clinical Practice Committee for hospital outpatients services. While neither rule includes any major ATS CPT Advisor policy shifts that will directly impact ATS members, there are a number of MICHAEL NELSON, MD reimbursement changes (positive and negative) that will affect procedure code Member, ATS Clinical Practice Committee ATS Alternate CPT Advisor families of interest to ATS members. This issue will both alert you to these STEVE G. PETERS, MD payment changes and provide some background on why these reimbursement Member, ATS Clinical Practice Committee changes are happening. The New Year will bring in some revised CPT codes of interest to the ATS In This Issue community. This issue explains these revised CPT codes. Also covered in Revised CPT Codes for 2018, page 2 this edition is news about the revised ICD-10-CM codes for pulmonary hypertension. While the revised family of codes was in use starting Oct. -
Icd-9-Cm (2010)
ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular -
Assessment and Retrieval of Aspirated Tracheoesophageal Prosthesis in the Ambulatory Setting
UCLA UCLA Previously Published Works Title Assessment and Retrieval of Aspirated Tracheoesophageal Prosthesis in the Ambulatory Setting. Permalink https://escholarship.org/uc/item/7pv2g71t Authors Dewan, Karuna Erman, Andrew Long, Jennifer L et al. Publication Date 2018 DOI 10.1155/2018/9369602 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Hindawi Case Reports in Otolaryngology Volume 2018, Article ID 9369602, 4 pages https://doi.org/10.1155/2018/9369602 Case Report Assessment and Retrieval of Aspirated Tracheoesophageal Prosthesis in the Ambulatory Setting Karuna Dewan , Andrew Erman, Jennifer L. Long, and Dinesh K. Chhetri Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA Correspondence should be addressed to Karuna Dewan; [email protected] Received 14 June 2018; Accepted 26 August 2018; Published 13 September 2018 Academic Editor: Marco Berlucchi Copyright © 2018 Karuna Dewan et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tracheoesophageal prosthesis (TEP) is the most common voice restoration method following total laryngectomy. Prosthesis extrusion and aspiration occurs in 3.9% to 6.7% and causes dyspnea. Emergency centers are unfamiliar with management of the aspirated TEP. Prior studies report removal of aspirated TEP prostheses under general anesthesia. Laryngectomees commonly have poor pulmonary function, posing increased risks for complications of general anesthesia. We present a straightforward approach to three cases of aspirated TEP prosthesis removed in the ambulatory setting. In each case, aspirated TEP was diagnosed with flexible bronchoscopy under local anesthesia at the time of consultation, and all prostheses were retrieved atraumatically using a biopsy grasper forceps inserted via the side channel of the bronchoscope. -
FY 2009 Final Addenda ICD-9-CM Volume 3, Procedures Effective October 1, 2008
FY 2009 Final Addenda ICD-9-CM Volume 3, Procedures Effective October 1, 2008 Tabular 00.3 Computer assisted surgery [CAS] Add inclusion term That without the use of robotic(s) technology Add exclusion term Excludes: robotic assisted procedures (17.41-17.49) New code 00.49 SuperSaturated oxygen therapy Aqueous oxygen (AO) therapy SSO2 SuperOxygenation infusion therapy Code also any: injection or infusion of thrombolytic agent (99.10) insertion of coronary artery stent(s) (36.06-36.07) intracoronary artery thrombolytic infusion (36.04) number of vascular stents inserted (00.45-00.48) number of vessels treated (00.40-00.43) open chest coronary artery angioplasty (36.03) other removal of coronary obstruction (36.09) percutaneous transluminal coronary angioplasty [PTCA] (00.66) procedure on vessel bifurcation (00.44) Excludes: other oxygen enrichment (93.96) other perfusion (39.97) New Code 00.58 Insertion of intra-aneurysm sac pressure monitoring device (intraoperative) Insertion of pressure sensor during endovascular repair of abdominal or thoracic aortic aneurysm(s) New code 00.59 Intravascular pressure measurement of coronary arteries Includes: fractional flow reserve (FFR) Code also any synchronous diagnostic or therapeutic procedures Excludes: intravascular pressure measurement of intrathoracic arteries (00.67) 00.66 Percutaneous transluminal coronary angioplasty [PTCA] or coronary atherectomy Add code also note Code also any: SuperSaturated oxygen therapy (00.49) 1 New code 00.67 Intravascular pressure measurement of intrathoracic -
Rigid Laryngoscopy, Oesophagoscopy and Bronchoscopy in Adults
OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY RIGID LARYNGOSCOPY, OESOPHAGOSCOPY & BRONCHOSCOPY IN ADULTS Johan Fagan, Mark De Groot Adult bronchoscopy, rigid oesophagoscopy teeth (Figure 3). Ask a dentist to make a and laryngoscopy for both diagnostic and customised guard for patients with therapeutic reasons are generally done abnormal teeth (Figure 4) or fashion one in under general anaesthesia. Panendoscopy the operating room from thermoplastic (all 3 procedures) is commonly performed sheeting (Figures 5a, b). to rule out synchronous primaries with squamous cell cancer of the upper aerodi- gestive tract. This chapter covers the tech- niques, pitfalls and safety measures of these 3 procedures. Morbidity of rigid endoscopy Sharing the airway with an anaesthetist requires close communication and a good understanding between surgeon and anaes- thetist. Figure 1: Protecting the lips with the fingers of the non-dominant hand It is surprising how often rigid endoscopy causes minor extralaryngeal and extra- oesophageal trauma. It is extremely easy to tear or perforate the delicate tissues that line the upper aerodigestive tract; this can lead to deep cervical sepsis, mediastinitis and death. Consequently it is important that a surgeon exercises extreme caution and knows when to abandon e.g. a difficult oesophagoscopy procedure. Mucosal injury occurs in up to 75% of cases and commonly involves the lips or Figure 2: Endoscopes exert excessive 1 angles of the mouth . To protect especially lateral pressure on the teeth to either side the lower lip one should advance the scope of a gap between the front teeth over the fingers of the non-dominant hand (Figure 1). -
Approved Surgical Procedures
UNION MEDICAL BENEFITS SOCIETY LTD APPROVED SURGICAL PROCEDURES The following list of surgical procedures should be read in conjunction with your policy document. If you are intending to have one of the listed procedures, please call our surgical team on 0800 600 666 so we can guide you through the prior approval process. If a surgical procedure is not listed below, it will not be covered unless UniMed decides, in its sole discretion, to offer cover. CARDIAC GENERAL • Pericardiotomy Breast • Pericardiocentesis • Breast Cyst Aspiration or Needle Biopsy • Drainage of Pericaridal Effusion • Breast Biopsy • Coronary Artery Bypass (using vein or artery) • Core Biopsy of Breast • Open Repair of Atrial Septal Defect (ASD) • Excision Accessary Breast Tissue • Valvuloplasty • Mastectomy • Aortic/ Mitral Valve Replacement via Sternotomy • Sentinel Node Biopsy with/without Axillary Dissection • Pulmonary Valve Replacement via Sternotomy • Breast Microdochotomy • Tricuspid Valve Replacement via Sternotomy • Balloon Valvuloplasty – Mitral/ Aortic Reconstruction Post Mastectomy • Pacemaker Surgery – Initial Implantation (Excluding the Cost • Breast/ Nipple Reconstruction of the Pacemaker) • Nipple Areolar Tattoo • Removal of Sternal Wire • Maze Arrhythmia Surgery Gastrointestinal • Removal & Rewiring of Sternal Wire • Anal Sphincterotomy • Maze Arrhythmia Surgery (Standalone procedure) • Simple Repair of Anal Fistula – Special approval only • Maze Procedure – Thoracoscopic • Anal Fistula Repair with Mucosal Advancement Flap • Bentall’s Procedure (includes -
Bronchoscopy Assisting
AARC GUIDELINE: BRONCHOSCOPY ASSISTING AARC Clinical Practice Guideline Bronchoscopy Assisting—2007 Revision & Update BA 1.0 PROCEDURE properties of the upper airway1,2,4,6,8 The role of the assistant in Bronchoscopy Assisting 4.3 The need to investigate hemoptysis, persis- (BA) tent unexplained cough, dyspnea, localized wheeze, or stridor1,2,4-8,10 BA 2.0 DESCRIPTION/DEFINITION 4.4 Suspicious or positive sputum cytology re- Bronchoscopy, fiberoptic or rigid, is an invasive sults1,2,4-6 procedure for visualization of the upper and lower 4.5 The need to obtain lower respiratory tract respiratory tract for the diagnosis and management secretions, cell washings, and biopsies for cyto- of a spectrum of inflammatory, infectious, and ma- logic, histologic, and microbiologic evalua- lignant diseases of the airway and lungs.1,2 Bron- tion1,2,4,7,9,11,12 choscopy may include retrieval of tissue specimens 4.6 The need to determine the location and ex- (bronchial brush, forceps, and needle), cell wash- tent of injury from toxic inhalation or aspira- ings, bronchoalveolar lavage, coagulation, or re- tion1,2,4,6 moval of abnormal tissue by laser. Bronchoscopy is 4.7 The need to evaluate problems associated widely used as a diagnostic and therapeutic tool for with endotracheal or tracheostomy tubes (tra- management of the airway.3 Bronchoscopy is per- cheal damage, airway obstruction, or tube formed by a specially trained physician broncho- placement)1,2,4-7 scopist and is assisted by a specially trained health- 4.8 The need for aid in performing difficult in- care professional (HCP).