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Preoperative Diagnoses: Oxygen Dependency

Question 689

Multiple Choice

Preoperative Diagnoses:
Oxygen dependency.
Chronic obstructive pulmonary disease.
Postoperative Diagnoses:
Oxygen dependency.
Chronic obstructive pulmonary disease.
Procedure Performed:
Tracheostomy with skin flaps.
SCOOP Procedure FastTract.
Indications: The patient is a 55-year-old male with a history of chronic obstructive pulmonary disease and O2 dependency of approximately 5 liters nasal cannula at home. The patient with extensive smoking history presents after risks, complications, and consequences of the SCOOP FastTract transtracheal oxygen procedure were explained.
Procedure: The patient was brought to operating suite by Anesthesia and placed on the operating table in the supine position. After this, the patient was then placed in reverse Trendelenburg. The patient's sternal notch along with cricoid and thyroid cartilages were noted and palpated and a sternal marker was utilized to mark the cricoid cartilage in the sternal notch. The midline was also marked and 1% lidocaine with epinephrine 1:100,000 at approximately 4 cc total was then utilized to localize the neck. A skin incision was then made in the midline in a vertical fashion. After this, the skin was retracted laterally and a small anterior jugular branch was clamped and cross clamped and tied. Further bleeding was controlled with monopolar cauterization and attention was then drawn down on to the strap muscles. The patient's sternohyoid muscle was identified and grasped on either side and the midline raphe was identified. Cauterization was then utilized to take down the midline raphe and further dissection was utilized with the skin hook and stat clamps. The anterior aspect of the thyroid isthmus was identified and palpation on the cricoid cartilage was performed. The cricoid cauterization over the cricoid cartilage was obtained with the monopolar cauterization and blunt dissection then was carried along the posterior aspect of the thyroid isthmus. Stats were then placed on either side of the thyroid isthmus and the mid portion was bisected with the monopolar cauterization. Next, the patient's anterior trachea was identified and cleaned with pusher. The cricoid cartilage along the first and second tracheal rings was identified. The cricoid hook was placed and the trachea was brought more anteriorly and superiorly. A small 4 mm punch was created within the tracheal cartilage using the punch in the SCOOP FastTract kit. A tracheal stent was placed within the tracheal punched lumen and the tracheal stent secured to the neck with a Vicryl strap. Then the cricoid hook was removed and the patient then had FiO2 on the monitor noted with pulse oximetry of 100%. The patient was transferred to the recovery room in stable condition.
Select the appropriate CPT and ICD-10-CM codes.


A) 31610, 31730, Z99.81, J44.9, F17.200
B) 31730, J44.9, Z99.81, Z72.0
C) 31610, 31730, J44.9, Z99.81, Z72.0
D) 31610, V46.2, J44.9, F17.200

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