The patient was brought to the Operating Room, underwent preoperative preparation, was anesthetized and placed on the table in a slightly flexed position. A right-sided chevron incision was made using the skin knife and Bovie. The peritoneum was opened. The falciform ligament was divided between 2 0 ties. The peritoneum was incised out laterally in the right colon and mesocoln reflected off the anterior surface of the kidney exposing the duodenum which was Kocherized and eventually the vena cava. The vena cava was then cleaned off and we isolated the left renal vein which was the lower margin of this tumor. The mass was palpable through the vein. The vena cava was then circumferentially dissected from the right renal vein up to the caudate vein. An umbilical tape was placed around it. This allowed the cava to be reflected laterally. The mass was now somewhat in view. We readjusted our Bookwalter retractor. We began first by taking down the attachments between the renal vein and this mass which were mostly fibrous. Obvious blood vessels were either tied off with 2 0 silk or divided between clips. We worked our way around the left side of this tumor where there were several small arterial attachments. At this point the tumor was rather tense and oozing freely. As we came across the top of this lesion the bleeding suddenly ceased. We had divided a rather large pedicle after a silk tie was placed.
Clinical Content Development Manager, Consulting Services and Outsource Services
There is a lot of confusion among coders and CDI specialists about the status of PSI-90. I hope to clear up a little of the confusion in this blog post, []
Terminology Standards and Interoperability
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Within the CMS proposed rule for FY2019 published at the end of April, there is a proposal to consolidate and improve the value-based purchasing (VBP) payment adjustment model. On the []
We were now able to lift the tumor up and the retroperitoneal attachments were minimal. We now had it attached by a right sided pedicle. We could now see a vein coming out of the tumor and wrapping around the lateral edge of the vena cava. We stapled this pedicle using the endovascular GIA stapler. The tumor was now soft and almost free. The remaining attachments were bovied and the specimen delivered. There were several small little bleeders now on the arterial side of the tumor cavity. These were dealt with with a series of small clips. On the vena cava side there was one venous bleeder with the fat with we tied off using a right angle and 2 0 silk. We closed our incision in two layers using a series of 1 PDS sutures. We closed the skin with staples. A dressing was applied. The patient was taken to the Recovery Room.
ICD-10 coding challenge: Extra-adrenal pheochromocytoma
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May 23rd, 2018 / ByCheryl Manchenton, RN
Assign the ICD-10-CM diagnosis and ICD-10-PCS procedure codes for this inpatient operative procedure.
POSTOPERATIVE DIAGNOSIS: Paraganglioma PATHOLOGICAL DIAGNOSIS: Paraganglioma
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We live in a communication age that embraces abbreviations and acronyms as a natural secondary language. Our emotions and reactions are reflected in LOLs and emojis on a regular basis. []
PROCEDURE: Exploratory laparotomy with excision of extra-adrenal pheochromocytoma
May 16th, 2018 / ByRichard Fuller, MS
Susan Belley, M.Ed., RHIA, CPHQ, is the manager of clinical content development and the manager of outsource services within the Consulting Services business of 3M Health Information Systems. She is
July 24th, 2017 / BySue Belley, RHIA
On March 29, 2012, President Obamas administrators announced the $200 million dollar R&D investment in the big data project. According to the press release, the Big Data Research and Development []
A 62-year old female presented to the Emergency Department with a chief complaint of severe headaches that had been worsening in intensity/frequency over the past three weeks. The patient was found to be hypertensive as well. Laboratory investigation revealed elevated urinary metanephrines. A CT scan of the abdomen and pelvis revealed a 4.7 cm mass located between the vena cava and the aorta consistent with an extra-adrenal pheochromocytoma. A follow up nuclear medicine study demonstrated that this was a solitary lesion. The patient was offered an open resection of the tumor. The decision was made to surgically remove the lesion as outlined in the operative report below.
In my most recent blog, I discussed in general why the capacity of ICD-10-PCS has limits, and how multi-axial structure and hierarchy together define those limits. This time Im going []
Sue Belley, RHIAis a clinical content development manager with the consulting services business of 3M Health Information Systems.
ICD-10 coding challenge: Extra-adrenal pheochromocytoma
PREOPERATIVE DIAGNOSIS: Extra-adrenal pheochromocytoma
April 12th, 2012 / ByBarbara Aubry, RN
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Quality and integrity were the final syntheses at the end of the journey for enlightenment in Zen and the Art of Motorcycle Maintenance. As is true of many things in []
PATHOLOGICAL DIAGNOSIS: Paraganglioma
Terminology Standards and Interoperability
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