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what are the CPT AND ICD CODES FOR THE FOLLOWING. Operative report PREOPERATIVE DIAGNOSES: 1. Ptosis, mechanical, right upper lid. 2. Loss of superior visual field secondary to #1. 3. Superior hemianopia secondary to #l, right eye. POSTOPERATIVE DIAGNOSES: Same. PROCEDURE PERFORMED: Fasanella – Servat procedure, right upper lid. ANESTHESIA: General endotracheal. INDICATIONS: This 57 – year – old white female has had progressively drooping lid on her right for many years from the weight of excess skin which has now reduced her superior visual field in the right eye and has actually limited her vision. After the prior approval and the photos and documentation were obtained, it was noted that the patient did have a 3 – to 4 – mm ptosis of the right upper lid and we would approach this with a Fasanella – Servat procedure. The risk of infection, hemorrhage, and reoperations were discussed. PROCEDURE: After the patient was placed under suitable general endotracheal anesthesia, the superior tarsal border was then marked with a marking pen and a 15 Bard – Parker blade cut down through skin to the muscle area. The lid was then everted on a Desmarres retractor and two curved mosquitos were then placed with the point central and pointing superiorly when the lid was everted. A 6 – 0 gut rapid absorbing suture was then started through the skin incision at the superior tarsal border and then a purse string was then woven along the curve tips and then the 3 to 4 mm resection was then obtained and then the serpentine 6 – 0 gut suture was then approximated without cutting it and brought out through the skin and tied. It was allowed to retract into the knot. There was no bleeding and there was no cut suture. Maxitrol ointment, a Telfa pad, and patch was applied and the patient was sent to the recovery room. There were no complications.

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