Preoperative Diagnosis: Advanced Primary Open Angle Glaucoma, Right Eye, with Related

Multiple Choice

Preoperative Diagnosis: Advanced primary open angle glaucoma, right eye, with related cortical cataract, right eye.
Procedure: Trabeculectomy.
Phacoemulsification and posterior chamber IOL insertion.
Postoperative Diagnosis: Advanced primary open angle glaucoma, right eye, with related cortical cataract, right eye.
Operation: The patient was brought in to the operating room on an eye stretcher and placed in the supine position. A peribulbar block using an equal concentration of 2% lidocaine and 0.5% Marcaine was administered and the right eye was draped and prepped in the usual sterile ophthalmic fashion and the microscope was brought in position. We placed a Lieberman lid speculum between the lid fissures on the right eye, then placed a superior rectus bridle suture to stabilize the eye. We created a superior peritomy using Vannas scissors and Bishop forceps. Next we used the cautery to outline a 3x4mm rectangular scleral flap. After applying mitomycin 0.2 mg/mL to the sclera and conjunctiva for two minutes per the clock, I thoroughly irrigated the area with saline. I then dissected the scleral flap using a #68 Beaver blade. I created a 2.70mm incision on the cornea under the scleral flap using a standard blade and created a primary posterior capsulorhexis using a cystotome and forceps. Hydrodissection of the lens nucleus was performed, then we did the phacoemulsification without difficulty and the area was irrigated with saline and the cortical remnants removed. We inserted an AcrySof® Aspheric IOL Model SN60WF +25 into the capsular sac and centered it without difficulty. We then created the internal sclerostomy under the scleral flap, measuring 1x2.5mm. We removed the limbal material with a Kelly punch.
Next we created a peripheral iridectomy using Dewecker scissors and closed the scleral flap using 5 interrupted 10-0 nylon sutures, being attentive to carefully control the tension. When the tension allowed egress of aqueous, we tied off and buried the sutures. We reapproximated the conjunctival flap and suture it into position using 9-0 nylon mattress sutures and 8-0 Vicryl running sutures. We checked intraolcular pressure manually with a cannula and it was within normal limits. We applied Gentamicin 20 mg under the conjunctiva and erythromycin on the conjunctiva. We removed the lid speculum, closed the eyelids and placed a patch and shield over the eye. The patient tolerated the procedure well and was transferred to recovery in good condition.
Select the appropriate CPT and ICD-10-CM codes.

A) 65850, 66984, H40.11X3, H25.011
B) 65850, 66982, H40.11X3, H26.221
C) 66170, 66982, H40.11X3
D) 66170, 66984, H40.11X3, H26.221