Wiki Cardiology Coding Question

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kokomax

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Can someone help me code this procedure please:

Procedure Name
ELG placement for an infrarenal abdominal aortic aneurysm. Coil embolization of an accessory right renal artery connected to the aneurysm.
Indication
Infrarenal abdominal aortic aneurysm measuring at 5.7 cm.
Details:
After obtaining informed consent, the patient was brought to the Cath Lab. He was prepped and draped in order to obtain a sterile field. General anesthesia was administered by Dr. Wilms. The right groin was anesthetized with 1% lidocaine. The right common femoral artery was cannulated using modified Seldinger technique with a micropuncture kit and ultrasound guidance upgraded to a 6 French sheath. Then 2 Perclose devices were predeployed. Following which an 8 French sheath was placed. The left groin was anesthetized with 1% lidocaine. The left common femoral artery was cannulated using modified Seldinger technique with a micropuncture kit upgraded to a 6 French sheath. #1 Perclose device was predeployed. At this point over a stiff wire the 8 French sheath from the right common femoral artery was removed and an 18 French sheath was advanced. On the left side again over a stiff wire the 6 French sheath was removed and the 12 French sheath was advanced over the stiff wire. Then the patient was anticoagulated with IV heparin. A marked pigtail catheter was placed from the left common femoral artery into the abdominal aorta, angiography was performed that showed an infrarenal abdominal aortic aneurysm. There was an accessory left renal artery in the neck of the aneurysm however there was another accessory right renal artery feeding the lower pole of the right kidney connected to the aneurysm. So we decided at this point to go ahead and coil the accessory right renal artery. So the RDC catheter was taken to cannulate that vessel. Then over the supracore wire an angled Terumo catheter was advanced into the mid right renal artery. Multiple calls were placed there were 4 mm x 7 cm, 5 mm time 11 cm twice and 6 mm x 9 cm. Angiography was performed that showed no flow in that vessel. At this point repeat angiography from the pigtail catheter was performed. Following which a Gore excluder conformable device measuring 28 x 14 x 12 mm was placed below the lowest renal artery which was the accessory left renal artery. The main body was deployed. Then we were able to cannulate the contralateral limb and that was coming from the left common femoral artery. Angiography was performed using a marked pigtail catheter following which an 18x12 limb was deployed from the divider all the way to the distal left common iliac artery. Then the ipsilateral limb was deployed from the main body. Following which a 14/10 limb was taken from the right common femoral artery to overlap with the main limb of the graft. Of note that the limbs were crossed. Then the main graft and both limbs were postdilated with the Gore balloon. The pigtail catheter was taken again from the left common femoral artery and angiography was performed that showed no evidence of endoleak exclusion of the aneurysm. And preservation of both renal arteries and the accessory left renal artery. At this point the Perclose device was deployed into the left common femoral artery however hemostasis was not achieved we will try to deploy another Perclose that was not successful. Anticoagulation was reversed with protamine, and manual compression was held for 20 minutes and good hemostasis was obtained. Angiography was performed again that showed no evidence of extravasation from the left common femoral artery. Also there was good flow in the graft in both limbs. At this point the 2 Perclose devices were deployed into the right common femoral artery, again hemostasis was not achieved so an 8 French Angio-Seal was deployed with good hemostasis. Overall the patient tolerated well the procedure there was no complications. He left the catheterization laboratory hemodynamically stable and neurologically intact.
In conclusion successful exclusion of an infrarenal abdominal aortic aneurysm. The patient will be taken for to the recovery room. Pending on his progress we will make further recommendations.
 
0
kokomax said:
Can someone help me code this procedure please:

Procedure Name
ELG placement for an infrarenal abdominal aortic aneurysm. Coil embolization of an accessory right renal artery connected to the aneurysm.
Indication
Infrarenal abdominal aortic aneurysm measuring at 5.7 cm.
Details:
After obtaining informed consent, the patient was brought to the Cath Lab. He was prepped and draped in order to obtain a sterile field. General anesthesia was administered by Dr. Wilms. The right groin was anesthetized with 1% lidocaine. The right common femoral artery was cannulated using modified Seldinger technique with a micropuncture kit and ultrasound guidance upgraded to a 6 French sheath. Then 2 Perclose devices were predeployed. Following which an 8 French sheath was placed. The left groin was anesthetized with 1% lidocaine. The left common femoral artery was cannulated using modified Seldinger technique with a micropuncture kit upgraded to a 6 French sheath. #1 Perclose device was predeployed. At this point over a stiff wire the 8 French sheath from the right common femoral artery was removed and an 18 French sheath was advanced. On the left side again over a stiff wire the 6 French sheath was removed and the 12 French sheath was advanced over the stiff wire. Then the patient was anticoagulated with IV heparin. A marked pigtail catheter was placed from the left common femoral artery into the abdominal aorta, angiography was performed that showed an infrarenal abdominal aortic aneurysm. There was an accessory left renal artery in the neck of the aneurysm however there was another accessory right renal artery feeding the lower pole of the right kidney connected to the aneurysm. So we decided at this point to go ahead and coil the accessory right renal artery. So the RDC catheter was taken to cannulate that vessel. Then over the supracore wire an angled Terumo catheter was advanced into the mid right renal artery. Multiple calls were placed there were 4 mm x 7 cm, 5 mm time 11 cm twice and 6 mm x 9 cm. Angiography was performed that showed no flow in that vessel. At this point repeat angiography from the pigtail catheter was performed. Following which a Gore excluder conformable device measuring 28 x 14 x 12 mm was placed below the lowest renal artery which was the accessory left renal artery. The main body was deployed. Then we were able to cannulate the contralateral limb and that was coming from the left common femoral artery. Angiography was performed using a marked pigtail catheter following which an 18x12 limb was deployed from the divider all the way to the distal left common iliac artery. Then the ipsilateral limb was deployed from the main body. Following which a 14/10 limb was taken from the right common femoral artery to overlap with the main limb of the graft. Of note that the limbs were crossed. Then the main graft and both limbs were postdilated with the Gore balloon. The pigtail catheter was taken again from the left common femoral artery and angiography was performed that showed no evidence of endoleak exclusion of the aneurysm. And preservation of both renal arteries and the accessory left renal artery. At this point the Perclose device was deployed into the left common femoral artery however hemostasis was not achieved we will try to deploy another Perclose that was not successful. Anticoagulation was reversed with protamine, and manual compression was held for 20 minutes and good hemostasis was obtained. Angiography was performed again that showed no evidence of extravasation from the left common femoral artery. Also there was good flow in the graft in both limbs. At this point the 2 Perclose devices were deployed into the right common femoral artery, again hemostasis was not achieved so an 8 French Angio-Seal was deployed with good hemostasis. Overall the patient tolerated well the procedure there was no complications. He left the catheterization laboratory hemodynamically stable and neurologically intact.
In conclusion successful exclusion of an infrarenal abdominal aortic aneurysm. The patient will be taken for to the recovery room. Pending on his progress we will make further recommendations.
Click to expand...
Looks like 34705, 34713,XU & 37242 to me.

Hope this helps!
 
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