Need CPT and ICD code For the following case

Report

The anesthesiologist personally provided the anesthesia care. The patient's physical status was -P4. LOCATION: Inpatient, Hospital

PATIENT: Kelsey Ducsavage

PHYSICIAN: Gary I. Sanchez, M.D.

ANESTHESIOLOGIST: Janice E. Larson, M.D.

PREOPERATIVE DIAGNOSIS: Crigler-Najjar Syndrome.

POSTOPERATIVE DIAGNOSIS: Same.

PROCEDURES: 1. Orthotopic liver transplant. 2. Temporary portacaval shunt.

ANESTHESIA: General

ESTIMATED BLOOD LOSS: Less than 100 ml.

INDICATIONS: This patient is a 10-year-old boy with Crigler-Najjar syndrome. He was listed for transplantation about 4 months ago. A donor became available. The liver was procured and sent to our center. I performed a back table dissection in the immediate preoperative period. The hepatic artery and arterial anatomy were normal. The liver was comfortable size to the recipient.

DESCRIPTION OF PROCEDURE: He was placed on the table in supine position and general anesthesia was induced. The abdomen was prepped and draped in a sterile manner. We made a standard bilateral subcostal incision with a vertical extension. We entered the abdominal cavity. There was no evidence of ascites or retention present. We then placed the appropriate retractors in the subcostal position. The liver itself had a relatively unremarkable appearance and without evidence of chronic disease, which was not unexpected. His disease consists primarily of a metabolic syndrome. Therefore, the liver was grossly unremarkable. We began by performing a portal dissection. We identified the junction of the cystic duct and common duct. The cystic duct was ligated, and we transected the common duct just above this. We identified left and right branches of hepatic artery and dissected this back. The gastroduodenal also came off at this site. Therefore, the branches were trifurcated. We ligated the right and left branches leaving the gastroduodenal intact. The portal vein was then dissected off for a length of about 3 cm. We clamped the portal vein at the hilum and transected it by oversewing the hepatic side. We then rotated the vein down for an end-to-side portacaval shunt. This was done with a 5-0 Prolene. After completion of the shunt, we performed the recipient hepatectomy. The right and left lobes were mobilized, and the liver was taken off the vena cava with numerous small branches ligated, large accessory right hepatic vein branch was sutured. We then placed a cross-clamp at the hepatic veins and removed the liver. We were able to open the cuff of all 3 hepatic veins into a single orifice, which did perfectly in size to the donor suprahepatic cava. The liver was then brought into the field, and the suprahepatic cava anastomosis was done using a 4-0 Prolene. We then ligated the portacaval shunt and shortened the donor portal vein appropriately and performed an end-to-end portal vein anastomosis with a 5-0 Prolene. We flushed the liver with lactated Ringer's just prior to completing the anastomosis. We then reperfused the liver allowing the initial pass of blood out the infrahepatic cava, which was then ligated with a 0 silk tie. It was extremely stable during the reperfusion. We then pursued immediately to hepatic artery anastomosis. The gastroduodenal branch was ligated, and we clamped the native hepatic artery and transected it proximal to the various branches. The diameter of the native artery was surprisingly small. We dilated this pretty gently. It corresponded in size to the common hepatic artery of the donor. Therefore, we resected the celiac trunk and all the other branches and performed an end-to-end anastomosis of donor to recipient common hepatic arteries. This was done with interrupted 7-0 Prolene sutures. We then released the clamp. There was good flow in liver. We applied some topical vasodilators with good results. We took a very short break at this point, during which patient was monitored, and returned in about 10 minutes. There was adequate hemostasis. We proceeded immediately to the bile duct anastomosis. The donor and recipient ducts were approximately same diameter. The donor duct was shortened appropriately, and then, we performed an end-to-end anastomosis with a running 6-0 PDS. At this point, we checked the operative site for hemostasis, which continued to be excellent. Sponge and lap counts were verified. We closed the abdomen with a 0 Prolene for fascia. We placed 1 closed suction drain in the subhepatic space. The skin was closed with staples. Overall, he tolerated the procedure extremely well. Estimated blood loss for the entire operation was less than 100 ml. He was taken to intensive care unit in stable condition. Pathology pending