mquiroz
Contributor
Hello,
I am new to ELG's I need help coding the following report:
INDICATIONS FOR THE PROCEDURE: The patient is a 78-year-old male with
an abdominal aortic aneurysm. He has a complex aneurysm with a posterior penetrating
aortic ulcer, proximal juxta-renal saccualr AAA, and a inra-renal fusiform AAA. Due to
the multilevel anatomy of the aortic pathology we proceeded with a fenestrated endoluminal
graft repair. The patient was taken to the operating room on an elective basis.
PROCEDURE IN DETAIL: The patient was taken to the operating room,
placed supine on the operating table. General endotracheal anesthesia
was achieved. All invasive monitoring lines were placed by the
anesthesiologist and the OR staff. The chest, abdomen, pelvis, and
bilateral lower extremities were prepped and draped in standard surgical
fashion. Percutaneous retrograde bilateral common femoral
arterial access was obtained with the micropuncture kit. Bilateral iliofemoral
angiograms were performed to verify correct common femoral artery access.
Retrograde access of both common femoral arteries was obtained with two
6-French sheaths. A 20-French Cook sheath was placed in the left
common femoral artery. The tip of this 20-French sheath was above the
aortoiliac bifurcation. Over an Amplatz wire on the right sheath, the
Cook Zenith fenestrated proximal component size 28 x 94 was
advanced in the proper orientation and positioned with the fenestrations
at the level of the renal arteries. An abdominal aortogram was
performed with repeat magnification view to identify both right and left
renal arteries. The proximal fenestrated component was positioned with
the right renal fenestration at the level of the right renal artery. This
proximal fenestrated component was partially deployed. Multiple wire
and catheter exchanges were used to introduce a wire followed by a 6-
French Ansel sheath and an iCAST stent into each renal artery. Mild
manipulation and adjustment of the position of the proximal component
was performed during the cannulation and instrumentation of both renal
arteries. With the 3 devices in each renal artery, the proximal
component was completely deployed. The proximal fenestrated aortic
device was balloon angioplastied with a 32 mm Coda balloon. The left renal
artery iCAST stent size 5x22 mm was then deployed after which the
proximal aortic end was flared using a 10 mm balloon. The same procedure
was performed on the right side with deployment of the right iCAST renal
artery stent size 6x22 mm with balloon angioplasty flaring of its proximal end in the
abdominal aorta. The delivery device of the proximal component was
then withdrawn. The Zenith fenestrated endograft distal bifurcted device was then
advanced over the left femoral wire and positioned with the proper
overlap with the proximal component and sheath then deployed releasing
the contralateral limb. The contralateral limb was cannulated with a
Glidewire. The position of the contralateral wire and the contralateral
limb was verified using a Coda balloon. A retrograde right iliac
angiogram was performed to identify the takeoff of the left internal
iliac artery. The contralateral iliac limb extension, size 13 mm x 74 mm
was advanced and deployed with the proper overlap with the distal
abdominal component with the distal end of the left iliac limb extension
landing immediately proximal to the right internal iliac artery. A
retrograde left iliac angiogram was then performed to identify the
takeoff of the left internal iliac artery. A left iliac limb
extension, size 13 mm x 56 mm was advanced and deployed with the proper
overlap of the ipsilateral limb of the distal abdominal component making
sure to preserve the left internal iliac artery. A 32 mm Coda balloon
was advanced over the left wire and balloon angioplasty of all the
overlapping distal complements performed. 32 mm Coda balloon angioplasty
of both iliac limb extensions was performed. The Pigtail catheter was then
advanced into the proximal abdominal aorta. A completion abdominal
aortic angiogram with iliac runoff was performed. There was excellent
filling of the right and left renal arteries as well as teh SMA. There was no
evidence of any type 1 or 3 endoleaks. The was a delayed type 2 endoleak
of the proximal saccualr juxtra-renal AAA component. A lateral abdominal
angiogram was perfopmred showing good filling of the SMA. All the wires and
sheaths were then withdrawn. The right and left femoral artery access sites were
secured using the pre-deployed Perclose Proglide vessel closure devices.
Excellent hemostasis of the access sites was obtained. The patient tolerated
the procedure well. There was no evidence of any hemodynamic instability or
compromise during the entire procedure. Heparin was administered
intravenously at the beginning of the procedure and reversed with
protamine at the end of the procedure. The patient was extubated in the
operating room. The patient was transported to the recovery room in
stable hemodynamic and respiratory condition.
I believe the CPT code for this procedure is 34846...but would that be all I can code? Seems like there is so much work involved for one single procedure code. Would the extensions qualify for the 34825 and 34826? If someone would be so kind to help me with this report, I would greatly appreciate it.
Thank you
I am new to ELG's I need help coding the following report:
INDICATIONS FOR THE PROCEDURE: The patient is a 78-year-old male with
an abdominal aortic aneurysm. He has a complex aneurysm with a posterior penetrating
aortic ulcer, proximal juxta-renal saccualr AAA, and a inra-renal fusiform AAA. Due to
the multilevel anatomy of the aortic pathology we proceeded with a fenestrated endoluminal
graft repair. The patient was taken to the operating room on an elective basis.
PROCEDURE IN DETAIL: The patient was taken to the operating room,
placed supine on the operating table. General endotracheal anesthesia
was achieved. All invasive monitoring lines were placed by the
anesthesiologist and the OR staff. The chest, abdomen, pelvis, and
bilateral lower extremities were prepped and draped in standard surgical
fashion. Percutaneous retrograde bilateral common femoral
arterial access was obtained with the micropuncture kit. Bilateral iliofemoral
angiograms were performed to verify correct common femoral artery access.
Retrograde access of both common femoral arteries was obtained with two
6-French sheaths. A 20-French Cook sheath was placed in the left
common femoral artery. The tip of this 20-French sheath was above the
aortoiliac bifurcation. Over an Amplatz wire on the right sheath, the
Cook Zenith fenestrated proximal component size 28 x 94 was
advanced in the proper orientation and positioned with the fenestrations
at the level of the renal arteries. An abdominal aortogram was
performed with repeat magnification view to identify both right and left
renal arteries. The proximal fenestrated component was positioned with
the right renal fenestration at the level of the right renal artery. This
proximal fenestrated component was partially deployed. Multiple wire
and catheter exchanges were used to introduce a wire followed by a 6-
French Ansel sheath and an iCAST stent into each renal artery. Mild
manipulation and adjustment of the position of the proximal component
was performed during the cannulation and instrumentation of both renal
arteries. With the 3 devices in each renal artery, the proximal
component was completely deployed. The proximal fenestrated aortic
device was balloon angioplastied with a 32 mm Coda balloon. The left renal
artery iCAST stent size 5x22 mm was then deployed after which the
proximal aortic end was flared using a 10 mm balloon. The same procedure
was performed on the right side with deployment of the right iCAST renal
artery stent size 6x22 mm with balloon angioplasty flaring of its proximal end in the
abdominal aorta. The delivery device of the proximal component was
then withdrawn. The Zenith fenestrated endograft distal bifurcted device was then
advanced over the left femoral wire and positioned with the proper
overlap with the proximal component and sheath then deployed releasing
the contralateral limb. The contralateral limb was cannulated with a
Glidewire. The position of the contralateral wire and the contralateral
limb was verified using a Coda balloon. A retrograde right iliac
angiogram was performed to identify the takeoff of the left internal
iliac artery. The contralateral iliac limb extension, size 13 mm x 74 mm
was advanced and deployed with the proper overlap with the distal
abdominal component with the distal end of the left iliac limb extension
landing immediately proximal to the right internal iliac artery. A
retrograde left iliac angiogram was then performed to identify the
takeoff of the left internal iliac artery. A left iliac limb
extension, size 13 mm x 56 mm was advanced and deployed with the proper
overlap of the ipsilateral limb of the distal abdominal component making
sure to preserve the left internal iliac artery. A 32 mm Coda balloon
was advanced over the left wire and balloon angioplasty of all the
overlapping distal complements performed. 32 mm Coda balloon angioplasty
of both iliac limb extensions was performed. The Pigtail catheter was then
advanced into the proximal abdominal aorta. A completion abdominal
aortic angiogram with iliac runoff was performed. There was excellent
filling of the right and left renal arteries as well as teh SMA. There was no
evidence of any type 1 or 3 endoleaks. The was a delayed type 2 endoleak
of the proximal saccualr juxtra-renal AAA component. A lateral abdominal
angiogram was perfopmred showing good filling of the SMA. All the wires and
sheaths were then withdrawn. The right and left femoral artery access sites were
secured using the pre-deployed Perclose Proglide vessel closure devices.
Excellent hemostasis of the access sites was obtained. The patient tolerated
the procedure well. There was no evidence of any hemodynamic instability or
compromise during the entire procedure. Heparin was administered
intravenously at the beginning of the procedure and reversed with
protamine at the end of the procedure. The patient was extubated in the
operating room. The patient was transported to the recovery room in
stable hemodynamic and respiratory condition.
I believe the CPT code for this procedure is 34846...but would that be all I can code? Seems like there is so much work involved for one single procedure code. Would the extensions qualify for the 34825 and 34826? If someone would be so kind to help me with this report, I would greatly appreciate it.
Thank you