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Pre- and Postoperative Diagnosis ANESTHESIA: General This 64-year-old female patient was taken to the OR and...

Pre- and Postoperative Diagnosis ANESTHESIA: General This 64-year-old female patient was taken to the OR and placed in the supine position. An upper midline incision was made and retractors were placed. The LUQ was explored and splenic ligaments and the gastric veins were identified and divided. Dissection at the splenic hilum occurred and the splenic vessels were identified. The splenic artery and vein were double ligated, suture ligated, and divided. The entire spleen was removed and hemostasis was achieved. Blood loss was minimal. A drain was placed and the wound was closed in layers with #3-0 Vicryl for the deep layers and #4-0 Vicryl for the skin. The patient tolerated the procedure well and was taken to the postop recovery room in satisfactory condition. Procedure: Splenectomy with no complications. ICD-10-CM CODE (Principal Diagnosis): ICD-10-PCS CODE:

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Answer #1

Procedure: Splenectomy with no complications.

The codes are as follows:

ICD-10-CM CODE (Principal Diagnosis): Z90.81

ICD-10-PCS CODE: 07TP0ZZ

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