SPECIALTYCODING
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| Hi, I'm looking for some assistance with coding this report. I am looking at CPT codes 34705, 34709, I do not see where he placed an extension on the left. There are 2 new codes this year 34717 34718. I do not know if either apply. DATE OF EXAM: PREOPERATIVE DIAGNOSIS: Occluded right common iliac artery with claudication. POSTOPERATIVE DIAGNOSIS: Occluded right common iliac artery with claudication with significant amount of laminar thrombus in the infrarenal aorta. PROCEDURE PERFORMED: 1. Diagnostic aortogram. 2. Bifurcated stent graft placement in the infrarenal abdominal aorta down through both external iliac arteries. CONTRAST USED: Omnipaque 110 mL. FLUOROSCOPY TIME: 31.6 minutes. CLINICAL HISTORY: -year-old patient 3 years earlier had a stent graft placed in both common iliac arteries, however, has recurred with occluded right common iliac artery that was noted to be occluded at least since 02/2020. He now presents for diagnostic study and possible therapeutic intervention. Our anticipation is placing bifurcated stent graft because his infrarenal aorta is not normal and need to reconstruct the infrarenal aortic bifurcation. PROCEDURE: After full informed consent was obtained the patient was brought to the Angio suite where anesthesia administered was spinal anesthetic and we had adequate IV and IA access. We then cannulated both groins in a percutaneous fashion using ultrasound guidance and images were taken. A 6 French sheath was placed on the right and a 5 French sheath was placed on the left. We then traversed the right common iliac artery occlusion with an angled catheter and straight Glidewire up into the aorta. We then upsized both groin sheaths and placed 10 French Prostar devices. Sutures are sequestered to the side and not tied. We then dilated the right common iliac artery with an 8 mm balloon. INTERVENTIONAL PROCEDURE: Now that we have bilateral access in our groin, closure devices were placed. We then selected a 23 x 12 mm x 10 cm long IBE device by Gore. Then advanced it up the left side to the infrarenal aortic position and then deployed it. We cannulated the contralateral gate with wire, placed a 12 cm long 12 mm diameter limb extension on the left and then a 14 cm long limb extension on the right that was 10 mm in size and then put an additional 7 cm extender to it into the right external iliac artery. All segments were postdilated with balloon with nice angiographic and hemodynamic result although her sheaths were flow occlusive in both external iliac arteries due to the small size of these vessels. We then achieved hemostasis in both access sites by tying our posterior sutures. Small piece of Surgicel was left in the tract and then durable suture was used to close the skin. SUMMARY: Successful placement of bifurcated stent graft. Thank you. |
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