monbel
Contributor
Would coding 35081 & 35540 be correct? 
" Due to patients occlusive disease, they were not endovascular candidate, therefore,the patient underwent an open repair. Patient was taken to the operating room. Patient was properly identified. Patient was monitored with the appropriate arterial lines and pulmonary artery catheter. Patient was anesthetized and intubated. Patient was sterilely prepped and draped from nipples to knees. A time-out was then taken. Antibiotics were administered. A long midline incision was made, and a general exploration of the abdomen was unremarkable. Patient's small bowel was checked to the right. The transverse colon was retracted cephalad. The retroperitoneum was opened after dividing the ligament of Treitz. Proximal control above the aneurysm was gained just below the renal vein and renal arteries. The aorta did have diffuse calcifications, but the aorta was able to be clamped at this level. Next bilateral groin incisions were made and the common femoral arteries were dissected out. The common femoral arteries were heavily calcified, and dissection was carried out down onto the profunda femoral artery, which were patent. Retroperitoneal tunnels were then created with blunt dissection. The patient was then heparinized with 100 units per kg of heparin. An 18 x 9 bifurcated Dacron graft, utilized for the repair. The infrarenal aorta was clamped above the aneurysm and both iliac arteries were clamped with vascular clamps. The aneurysm was opened and intramural debris was evacuated. There are few lumbar drains, which has some back bleeding and these were oversewn with 2-0 silk sutures. The graft was then cut appropriately. The proximal anastomosis was done with a running 3-0 Prolene suture. Clamp was removed and this anastomosis was hemostatic. Both limbs of the graft were then tunneled through the respective retroperitoneal tunnels and the anastomoses to both of the femoral arteries were carried out individually with running 5- 0 Prolene sutures. The anastomoses were carried down onto the profunda femoral artery for better flow in the profunda femoral artery, given the status of the severely diseased superficial femoral arteries. Once these anastomoses were done, protamine was given. All suture lines were inspected for hemostasis. It should be noted that the aortic bifurcation was oversewn for hemostasis with a running 2-0 Prolene suture. Once the protamine was given, Patient tolerated it well, was apparent that there was no need to reimplant the inferior mesenteric artery as this was already included. The retroperitoneum was then closed.."
" Due to patients occlusive disease, they were not endovascular candidate, therefore,the patient underwent an open repair. Patient was taken to the operating room. Patient was properly identified. Patient was monitored with the appropriate arterial lines and pulmonary artery catheter. Patient was anesthetized and intubated. Patient was sterilely prepped and draped from nipples to knees. A time-out was then taken. Antibiotics were administered. A long midline incision was made, and a general exploration of the abdomen was unremarkable. Patient's small bowel was checked to the right. The transverse colon was retracted cephalad. The retroperitoneum was opened after dividing the ligament of Treitz. Proximal control above the aneurysm was gained just below the renal vein and renal arteries. The aorta did have diffuse calcifications, but the aorta was able to be clamped at this level. Next bilateral groin incisions were made and the common femoral arteries were dissected out. The common femoral arteries were heavily calcified, and dissection was carried out down onto the profunda femoral artery, which were patent. Retroperitoneal tunnels were then created with blunt dissection. The patient was then heparinized with 100 units per kg of heparin. An 18 x 9 bifurcated Dacron graft, utilized for the repair. The infrarenal aorta was clamped above the aneurysm and both iliac arteries were clamped with vascular clamps. The aneurysm was opened and intramural debris was evacuated. There are few lumbar drains, which has some back bleeding and these were oversewn with 2-0 silk sutures. The graft was then cut appropriately. The proximal anastomosis was done with a running 3-0 Prolene suture. Clamp was removed and this anastomosis was hemostatic. Both limbs of the graft were then tunneled through the respective retroperitoneal tunnels and the anastomoses to both of the femoral arteries were carried out individually with running 5- 0 Prolene sutures. The anastomoses were carried down onto the profunda femoral artery for better flow in the profunda femoral artery, given the status of the severely diseased superficial femoral arteries. Once these anastomoses were done, protamine was given. All suture lines were inspected for hemostasis. It should be noted that the aortic bifurcation was oversewn for hemostasis with a running 2-0 Prolene suture. Once the protamine was given, Patient tolerated it well, was apparent that there was no need to reimplant the inferior mesenteric artery as this was already included. The retroperitoneum was then closed.."