Question Answered step-by-step ADMITTING INFORMATION: SURGEON: Douglas Sweet, M.D. SERVICE:… ADMITTING INFORMATION: SURGEON: Douglas Sweet, M.D. SERVICE: Surgery PRIMARY CARE PROVIDER: Hiram W. Walker FINANCIAL CLASS: Commercial (COM) CODES ADMITTING DIAGNOSIS: Back cyst PRIMARY DIAGNOSIS: Back cyst PRIMARY PROCEDURE: Excision of back cyst PREOPERATIVE DIAGNOSIS: Back cyst. POSTOPERATIVE DIAGNOSIS: Same. PROCEDURES: Excision of back cyst. OPERATIVE PROCEDURES AND PATHOLOGICAL FINDINGS: Indications for surgery: The patient has an enlarging cyst on the upper mid-back. Findings at surgery: There was a 4 cm., upper mid-back cyst. DESCRIPTION OF PROCEDURE: With the patient supine, the back was prepped and draped in the usual sterile fashion. The skin and underlying tissues were anesthetized with 30 ccs. of 1% Lidocaine and Epinephrine. Through a 4 cm. transverse skin incision, the cyst was excised. Hemostasis was assured. The incision was closed using 3-0 Vicryl for the deep layers and running 3-0 Prolene subcuticular stitch with Steri-strips for the skin. The patient was returned to the ASU in stable postoperative condition. All sponge, needle and instrument counts were correct. Estimated blood loss is 0 ccs.CLINICAL DIAGNOSIS AND HISTORY: Cyst. TISSUE(S) SUBMITTED: Lesion, back. GROSS DESCRIPTION: Specimen is received in fixative and consists of a 3.3 x 2.5 x 2.2 cm. thin-walled cyst containing charcoal, gray-black, friable material. MICROSCOPIC DESCRIPTION: 1 microscopic slide examined. DIAGNOSIS: Follicular cyst, infundibular type, skin of back. I need ICD 10 CM code and CPT procedure code. Health Science Science Nursing NURSING 4570 Share QuestionEmailCopy link Comments (0)
Question Answered step-by-step ADMITTING INFORMATION: SURGEON: Douglas Sweet, M.D. SERVICE:… ADMITTING INFORMATION: SURGEON: Douglas Sweet, M.D. SERVICE: Surgery PRIMARY CARE PROVIDER: Hiram W. Walker FINANCIAL CLASS: Commercial (COM) CODES ADMITTING DIAGNOSIS: Back cyst PRIMARY DIAGNOSIS: Back cyst PRIMARY PROCEDURE: Excision of back cyst PREOPERATIVE DIAGNOSIS: Back cyst. POSTOPERATIVE DIAGNOSIS: Same. PROCEDURES: Excision of back cyst. OPERATIVE PROCEDURES AND PATHOLOGICAL FINDINGS: Indications for surgery: The patient has an enlarging cyst on the upper mid-back. Findings at surgery: There was a 4 cm., upper mid-back cyst. DESCRIPTION OF PROCEDURE: With the patient supine, the back was prepped and draped in the usual sterile fashion. The skin and underlying tissues were anesthetized with 30 ccs. of 1% Lidocaine and Epinephrine. Through a 4 cm. transverse skin incision, the cyst was excised. Hemostasis was assured. The incision was closed using 3-0 Vicryl for the deep layers and running 3-0 Prolene subcuticular stitch with Steri-strips for the skin. The patient was returned to the ASU in stable postoperative condition. All sponge, needle and instrument counts were correct. Estimated blood loss is 0 ccs.CLINICAL DIAGNOSIS AND HISTORY: Cyst. TISSUE(S) SUBMITTED: Lesion, back. GROSS DESCRIPTION: Specimen is received in fixative and consists of a 3.3 x 2.5 x 2.2 cm. thin-walled cyst containing charcoal, gray-black, friable material. MICROSCOPIC DESCRIPTION: 1 microscopic slide examined. DIAGNOSIS: Follicular cyst, infundibular type, skin of back. I need ICD 10 CM code and CPT procedure code. Health Science Science Nursing NURSING 4570 Share QuestionEmailCopy link Comments (0)
