How do you determine what code to use 61700 vs 61697. The Consult note states
A 4-vessel cerebral angiogram was performed on 02/06/2015, again revealing the moderate to large posteriorly directed paraclinoid aneurysm on the right ICA measuring 6.6 x 8.6 x 6 mm, with a 4.5 mm neck. Also 2nd left internal carotid artery aneurysm measuring 5.3 x 2.5 x 4.4 mm which was somewhat irregular.
The op Report states
We then used a Midas Rex drill to place 3 bur holes; 1 in the keyhole, 1 in the temporal fossa, 1 in the posterior end of the exposure. Using a B1 with a footplate, we turned a craniotomy flap.
We then did extradural dissection and drilled the medial sphenoid wing until we were flush with the base of the clinoid process. The dura was then opened in a curvilinear fashion, reflected forward. Carotid optic cistern was opened, and we achieved cerebral relaxation after the carotid optic cistern was opened and draining CSF. We dissected more and we were able to easily see the distal aspect of the neck of the aneurysm. Proximal aspect of the neck of the aneurysm could not be seen.
We then used the bipolar cautery to coagulate over the clinoid process and used a sharp 15 blade to dissect the pericranium off the base of the clinoid. After this was done, we used the Sonopet micro claw to do a clinoid resection and opened the distal dural ring. After this was done, a temporary clip was applied on the carotid artery in the neck, and we initially applied a permanent clip over the aneurysm, making sure there was good flow through the carotid artery.
Intraoperative angiogram was done at this point, which showed that there was still some filling from the proximal aspect of the neck. We then advanced the clip further up and reinforced it laterally, and did another angiogram Despite this, there was still some filling.
For the third time, we advanced the medial clip further and placed another reinforcing clip lateral to it, and did an intraop angio, at which point we noticed the aneurysm was completely secured, but seemed like there were multiple small clots in the distal MCA branches.
At this point, we took the angiographic catheter out and achieved hemostasis, and closure was done of the dura using 4-0 Vicryl suture in a watertight fashion
A 4-vessel cerebral angiogram was performed on 02/06/2015, again revealing the moderate to large posteriorly directed paraclinoid aneurysm on the right ICA measuring 6.6 x 8.6 x 6 mm, with a 4.5 mm neck. Also 2nd left internal carotid artery aneurysm measuring 5.3 x 2.5 x 4.4 mm which was somewhat irregular.
The op Report states
We then used a Midas Rex drill to place 3 bur holes; 1 in the keyhole, 1 in the temporal fossa, 1 in the posterior end of the exposure. Using a B1 with a footplate, we turned a craniotomy flap.
We then did extradural dissection and drilled the medial sphenoid wing until we were flush with the base of the clinoid process. The dura was then opened in a curvilinear fashion, reflected forward. Carotid optic cistern was opened, and we achieved cerebral relaxation after the carotid optic cistern was opened and draining CSF. We dissected more and we were able to easily see the distal aspect of the neck of the aneurysm. Proximal aspect of the neck of the aneurysm could not be seen.
We then used the bipolar cautery to coagulate over the clinoid process and used a sharp 15 blade to dissect the pericranium off the base of the clinoid. After this was done, we used the Sonopet micro claw to do a clinoid resection and opened the distal dural ring. After this was done, a temporary clip was applied on the carotid artery in the neck, and we initially applied a permanent clip over the aneurysm, making sure there was good flow through the carotid artery.
Intraoperative angiogram was done at this point, which showed that there was still some filling from the proximal aspect of the neck. We then advanced the clip further up and reinforced it laterally, and did another angiogram Despite this, there was still some filling.
For the third time, we advanced the medial clip further and placed another reinforcing clip lateral to it, and did an intraop angio, at which point we noticed the aneurysm was completely secured, but seemed like there were multiple small clots in the distal MCA branches.
At this point, we took the angiographic catheter out and achieved hemostasis, and closure was done of the dura using 4-0 Vicryl suture in a watertight fashion