Wiki Intracranial Aneurysm Coil

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mmarcum

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One of our surgeons dictated the following op note on a patient. I am at a loss for how to code this. Any advice would be appreciated.

DX: Intracranial aneurysm coil extending into the right common femoral artery

Procedure: Right common femoral cut down with exposure
Closure of the right common femoral artery puncture site
Stabilization of the coil fiber to the femoral artery as well as to
the suture

A 6 cm oblique incision was made over the right groin area. The incision was carried from the skin down through the subcutaneous tissue. The vertical incision was then carried out. This incision tracked along the existing right common femoral artery sheath. It was then dissected down to the common femoral artery. A 5-0 Prolene pursestring was then placed around the puncture site of the sheath. Within the sheath there was also the intracranial coil of fibers. The sheath was then slowly and carelfully removed over the fiber without pulling on the fiber. A pursestring was then closed to achive hemostasis. Subsequently, the aneurysm coil fiber was then used to wrap and tie down to the external adventitial area of the common femoral artery. Additionally, multiple loops of the fiber were also tied around the suture. Finally, the fiber itself was used as a suture and ties along with the existing suture. Additional sutures were then used to secure the fibers in place to the adventitial of the femoral artery wall. Hemostasis was achieved.
 
mmarcum said:
One of our surgeons dictated the following op note on a patient. I am at a loss for how to code this. Any advice would be appreciated.

DX: Intracranial aneurysm coil extending into the right common femoral artery

Procedure: Right common femoral cut down with exposure
Closure of the right common femoral artery puncture site
Stabilization of the coil fiber to the femoral artery as well as to
the suture

A 6 cm oblique incision was made over the right groin area. The incision was carried from the skin down through the subcutaneous tissue. The vertical incision was then carried out. This incision tracked along the existing right common femoral artery sheath. It was then dissected down to the common femoral artery. A 5-0 Prolene pursestring was then placed around the puncture site of the sheath. Within the sheath there was also the intracranial coil of fibers. The sheath was then slowly and carelfully removed over the fiber without pulling on the fiber. A pursestring was then closed to achive hemostasis. Subsequently, the aneurysm coil fiber was then used to wrap and tie down to the external adventitial area of the common femoral artery. Additionally, multiple loops of the fiber were also tied around the suture. Finally, the fiber itself was used as a suture and ties along with the existing suture. Additional sutures were then used to secure the fibers in place to the adventitial of the femoral artery wall. Hemostasis was achieved.
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There are a lot of unanswered questions but here goes:

35226 repair of blood vessel, lower extremity.

It seems to me that an attempted coil embolization went awry and the coil became dislodged. So, the surgeon opened the groin/leg and removed the sheath but left the coil (perhaps because removal may have caused more damage.?) He then repaired the damaged artery with the pursestring, sutures and coil fibers.

I hope this helps.
 
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