(SOLVED) Code the following using ICD-IO-CM and ICD-IO-PCS
Code the following using ICD-IO-CM and ICD-IO-PCS
Preoperative Diagnosis: Bronchial alveolar cell carcinoma of the right lower lobe of the lung
Postoperative Diagnosis: Same
Operation: Exploratory right thoracotomy. Right pneumonectomy
Procedures: This patient was operated on under general endotracheal anesthesia. we had a double lumen tube in where we could selectively ventilate both lungs. He was in the lateral decubitus position. we used a standard posterior lateral right thoracotomy incision and the chest was opened. There was one adhesion to the apical area which was not neoplastic in any manner. I took this down and we were able to easily mobilize the lung. There was a large diffuse lesion in the right lower lobe periphery. I really did not know what to do with this. The lesion had previously been biopsied, and we thought we were dealing with a bronchial alveolar cell. The man did have a past history of non-Hodgkin's lymphoma years ago which was presumably cured. I began dissecting on the pulmonary artery to look at things to see what kind of fissure I had developed, but the inner lobar branches were just too dense, that is, there was no fissure basically and I knew if I did a lobectomy it was really entering the tumor area peripherally. I therefore went ahead and elected to do a right pneumonectomy since his pulmonary function studies were satisfactory pre-op, and this was the best thing I thought. The main pulmonary artery was divided between a vascular staple gun. Dissection was a little tenuous. The artery seemed quite friable but it held nicely. I then reinforced this with a large Chromic tie. We divided the superior and inferior pulmonary vein and prepared for clamping of the bronchus. This completed the pneumonectomy. He lost some blood due to a bleeding adhesion up above which was not recognized until he had about a half a unit of blood in the left upper chest. This was suctioned clean and we transfused him with two units of packed cells. He tolerated the procedure well. He had some hypotension but he was hypotensive on induction throughout the entire procedure. Blood gases were satisfactory during clamping of the mainstem bronchus, and he seemed to be reacting well. We closed the chest in layers with Dexon pericostal sutures, approximated clips on the skin.
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