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Left neck exploration with aborted carotid endarterectomy

Date: Oct 3, 2022

Question:

Should I report code 35301 -53, or just the neck exploration with node excision?

"Dissection carried down through subq tissue and platysma to the level of the internal jugular vein with cautery. Facial vein was then identified and ligated with 2-0 silk ties proximally and distally along with medium clips; vein was transected with Metzenbaum scissors. Large reactive lymph node was noted overlying the ICA and mobilized and transected. It were passed off the field to be sent to path. Additional smaller veins were ligated distally with 3-0 silk and small clips. Internal jugular was then reflected laterally. Common carotid was then visualized & dissected circumferentially; red vessel loop was used to encircle. The internal, external, and the superior thyroid arteries identified and controlled with vessel loops. After dissection of the ICA, it was palpated gently and lesion was noted to be high. Maneuvers for more distal exposure were performed such as mobilizing the hypoglossal nerve, taking down part digastric muscle & ligating associated veins. Lesion still to high, proc aborted." 

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