Question CARDIOVASCULAR- HOW WOULD YOU CODE THIS?

Hbutler10

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Patient received preoperative IV antibiotics was brought the operating room placed under general tracheal anesthesia. Patient's right lower extremity and groin was prepped and draped standard fashion. Incision was made in the right groin and also on the medial aspect of the distal right thigh just above the knee. At the right groin and the soft tissue was evaluated with cautery. The common femoral artery was identified and cleared of surrounding soft tissue. The superficial femoral artery and profunda femoris artery were also identified and cleared of soft tissue as well. Vesseloops were placed around the common femoral artery in 1 side branch was also controlled with a small vessel loop with a Potts tie configuration. At the incision above the right knee medially underlying soft tissue was divided electrocautery. The popliteal space was entered and retractor inserted. The popliteal arteries identified and noted to be very calcific approximately and then became a softer vessel distally where the anastomosis would be completed. A tunneling device was then passed through the soft tissue and pulled in the place a 6 mm x 80 cm heparin-bonded reinforced PTFE graft. The patient then received 6000 units of heparin IV and 3 minutes was allowed to pass. Proximal distal control was obtained on the common femoral artery with padded Fogarty clamps. The anastomosis was created by making an arteriotomy followed by use of 5-0 Gore-Tex suture to create the anastomosis to the PTFE graft in a heel-to-toe fashion. Distally the graft was cut to the appropriate length and the anastomosis was completed to the popliteal artery with 6-0 Gore-Tex suture. An arthrotomy was made in large with Potts scissors and then the anastomosis completed in a heel-toe fashion with 6-0 Gore-Tex suture. Flow was then established at the femoral artery to the native vessel and then down the graft. Distally retrograde flow was established and then flow through the graft into the popliteal artery. There was good biphasic flow with a Doppler into the popliteal artery. Areas that were bleeding along the suture line at the distal anastomosis were reinforced and controlled with 6-0 Gore-Tex suture. Also bleeding was controlled at both anastomotic sites with Gelfoam and thrombin. Next the soft tissue was closed with 2 layers of 2-0 Vicryl suture and then the skin edges with 4-0 nylon in a vertical mattress technique with interrupted stitches. Sterile dressing was applied over Dermabond. Patient was then awakened and extubated brought to the recovery room in stable condition.
 

mk2001

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Patient received preoperative IV antibiotics was brought the operating room placed under general tracheal anesthesia. Patient's right lower extremity and groin was prepped and draped standard fashion. Incision was made in the right groin and also on the medial aspect of the distal right thigh just above the knee. At the right groin and the soft tissue was evaluated with cautery. The common femoral artery was identified and cleared of surrounding soft tissue. The superficial femoral artery and profunda femoris artery were also identified and cleared of soft tissue as well. Vesseloops were placed around the common femoral artery in 1 side branch was also controlled with a small vessel loop with a Potts tie configuration. At the incision above the right knee medially underlying soft tissue was divided electrocautery. The popliteal space was entered and retractor inserted. The popliteal arteries identified and noted to be very calcific approximately and then became a softer vessel distally where the anastomosis would be completed. A tunneling device was then passed through the soft tissue and pulled in the place a 6 mm x 80 cm heparin-bonded reinforced PTFE graft. The patient then received 6000 units of heparin IV and 3 minutes was allowed to pass. Proximal distal control was obtained on the common femoral artery with padded Fogarty clamps. The anastomosis was created by making an arteriotomy followed by use of 5-0 Gore-Tex suture to create the anastomosis to the PTFE graft in a heel-to-toe fashion. Distally the graft was cut to the appropriate length and the anastomosis was completed to the popliteal artery with 6-0 Gore-Tex suture. An arthrotomy was made in large with Potts scissors and then the anastomosis completed in a heel-toe fashion with 6-0 Gore-Tex suture. Flow was then established at the femoral artery to the native vessel and then down the graft. Distally retrograde flow was established and then flow through the graft into the popliteal artery. There was good biphasic flow with a Doppler into the popliteal artery. Areas that were bleeding along the suture line at the distal anastomosis were reinforced and controlled with 6-0 Gore-Tex suture. Also bleeding was controlled at both anastomotic sites with Gelfoam and thrombin. Next the soft tissue was closed with 2 layers of 2-0 Vicryl suture and then the skin edges with 4-0 nylon in a vertical mattress technique with interrupted stitches. Sterile dressing was applied over Dermabond. Patient was then awakened and extubated brought to the recovery room in stable condition.
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