endrest
Contributor
What codes would you use for this case? Most specifically for #3 & #4? I think I have the others figured out. The Unibody is confusing me - should it be 34804 & 34825 or possibly 34802 & 34825?
NAME OF OPERATION/PROCEDURE:
1. Bilateral common femoral exposures. (34812-50)
2. Placement of catheter in the aorta. (36200)
3. Placement of an endograft device.
4. Placement of an extension prosthesis distally to create a Unibody.
5. Radiology interpretation of the graft placement as well as extension
prostheses. (75952 & 75953)
6. A femorofemoral prosthetic graft.(34813)
7. Preoperative planning with 3D reconstruction and sizing. (G0288)
INDICATIONS FOR PROCEDURE:
This patient is a 71-year-old female with a history of having a known
aneurysm. It has increased over time. As well, she had complaints of
increased left lower extremity pain. Followup CT on her aneurysm had shown
her abdominal aortic aneurysm has increased to approximately 5.3 cm in
diameter. Of note, she also had occluded her left common iliac artery
distally. Based on the increase in size of her aneurysm as well the current
size, we decided we would go forward with a repair. Three-dimensional
reconstruction as well as preoperative mapping showed that she was an
adequate endovascular candidate. Based on her left iliac occlusion, she
would require main body placement as the Unibody as well as an iliac limb.
Risks and benefits discussed in detail with the patient were the risks of
bleeding, hemorrhage as well as MI. She wished to go forward with this plan
for rupture prevention as well as to increase flow to her left lower
extremity. She was having history of rest pain.
DESCRIPTION OF PROCEDURE:
At this time, there were
bilateral groin cutdowns performed. Went down to the common femoral arteries
bilaterally. They were noted to be of small caliber. She was also then
noted high-branching profundas bilaterally. We had to dissect up onto the
ilioinguinal ligament. Once this was performed, we then did a percutaneous
entry into the right groin. A diagnostic aortogram was performed. Also at
this time, a fem-fem tunnel had been created with the use of umbilical tape
placed. At this time, there was then evaluation and sizing based on the
aortogram. We decided at this time we would build up with a limb, which we
measured 16-13/124. This limb was placed distally above the hypogastric
artery. Following this, there was then placement of an aortic device with
suprarenal fixation. This was placed through the previous device and opened.
This was placed after several aortic angiograms confirmed position. This was
then deployed without difficulty. Fundus was then balloon angioplastied of
all the angulation as well the endpoints and seal zones. Once this was done,
there was completion angiogram showing good apposition, no type 1 leak.
There was a noted type 2 leak through a lumbar artery. At this time, a
Unibody graft was in place, showing good flow to the right lower extremity.
Prior to placing the graft, the patient received 6000 units of heparin. She
had an elevated ACT. She was redosed with 2000 units of heparin towards the
end of the case prior to the fem-fem. She continued to have an elevated ACT.
At this time, there was then clamping of the external
iliac onto the common femoral artery. There was increase in the arteriotomy
once the wire and sheath were removed. A 6 mm ring PTFE graft was then used
and placed through the previously created tunnel. This laid appropriately.
The end was spatulated. Following this, there was an end-to-side anastomosis
using CV5 suture starting at the heel and going in a clockwise and
counterclockwise direction. There was then flushing prior to opening of the
graft. There was now good pulsatility in the graft. The distal anastomosis
on the left common femoral artery was performed. There was then angulated
arteriotomy created of the common femoral into the SFA. The graft was
spatulated and cut to the appropriate size. This was then sewn in an end-to-
side fashion using a CV5 suture going in clockwise and counterclockwise
directions. At this time, there was now evaluation of the graft. It had
good pulsatility. The grafts had been flushed prior to completion of the
anastomosis. There was now good pulse in the graft. Evaluation with Doppler
had good triphasic signals distally. Pulsatile flow within the graft as well
as good triphasic signals on the left SFA and profunda. Hemostasis was
complete. There had been required one interrupted suture on the inflow for
hemostatic control. Fibrillar was used. The groins were then closed in
multiple layers using 2-0 and 3-0 Vicryl suture followed by subcuticular
stitches. Benzoin and Steri-Strips were applied. The patient tolerated this
procedure. No complications were noted.
Thanks for any guidance on this one!
NAME OF OPERATION/PROCEDURE:
1. Bilateral common femoral exposures. (34812-50)
2. Placement of catheter in the aorta. (36200)
3. Placement of an endograft device.
4. Placement of an extension prosthesis distally to create a Unibody.
5. Radiology interpretation of the graft placement as well as extension
prostheses. (75952 & 75953)
6. A femorofemoral prosthetic graft.(34813)
7. Preoperative planning with 3D reconstruction and sizing. (G0288)
INDICATIONS FOR PROCEDURE:
This patient is a 71-year-old female with a history of having a known
aneurysm. It has increased over time. As well, she had complaints of
increased left lower extremity pain. Followup CT on her aneurysm had shown
her abdominal aortic aneurysm has increased to approximately 5.3 cm in
diameter. Of note, she also had occluded her left common iliac artery
distally. Based on the increase in size of her aneurysm as well the current
size, we decided we would go forward with a repair. Three-dimensional
reconstruction as well as preoperative mapping showed that she was an
adequate endovascular candidate. Based on her left iliac occlusion, she
would require main body placement as the Unibody as well as an iliac limb.
Risks and benefits discussed in detail with the patient were the risks of
bleeding, hemorrhage as well as MI. She wished to go forward with this plan
for rupture prevention as well as to increase flow to her left lower
extremity. She was having history of rest pain.
DESCRIPTION OF PROCEDURE:
At this time, there were
bilateral groin cutdowns performed. Went down to the common femoral arteries
bilaterally. They were noted to be of small caliber. She was also then
noted high-branching profundas bilaterally. We had to dissect up onto the
ilioinguinal ligament. Once this was performed, we then did a percutaneous
entry into the right groin. A diagnostic aortogram was performed. Also at
this time, a fem-fem tunnel had been created with the use of umbilical tape
placed. At this time, there was then evaluation and sizing based on the
aortogram. We decided at this time we would build up with a limb, which we
measured 16-13/124. This limb was placed distally above the hypogastric
artery. Following this, there was then placement of an aortic device with
suprarenal fixation. This was placed through the previous device and opened.
This was placed after several aortic angiograms confirmed position. This was
then deployed without difficulty. Fundus was then balloon angioplastied of
all the angulation as well the endpoints and seal zones. Once this was done,
there was completion angiogram showing good apposition, no type 1 leak.
There was a noted type 2 leak through a lumbar artery. At this time, a
Unibody graft was in place, showing good flow to the right lower extremity.
Prior to placing the graft, the patient received 6000 units of heparin. She
had an elevated ACT. She was redosed with 2000 units of heparin towards the
end of the case prior to the fem-fem. She continued to have an elevated ACT.
At this time, there was then clamping of the external
iliac onto the common femoral artery. There was increase in the arteriotomy
once the wire and sheath were removed. A 6 mm ring PTFE graft was then used
and placed through the previously created tunnel. This laid appropriately.
The end was spatulated. Following this, there was an end-to-side anastomosis
using CV5 suture starting at the heel and going in a clockwise and
counterclockwise direction. There was then flushing prior to opening of the
graft. There was now good pulsatility in the graft. The distal anastomosis
on the left common femoral artery was performed. There was then angulated
arteriotomy created of the common femoral into the SFA. The graft was
spatulated and cut to the appropriate size. This was then sewn in an end-to-
side fashion using a CV5 suture going in clockwise and counterclockwise
directions. At this time, there was now evaluation of the graft. It had
good pulsatility. The grafts had been flushed prior to completion of the
anastomosis. There was now good pulse in the graft. Evaluation with Doppler
had good triphasic signals distally. Pulsatile flow within the graft as well
as good triphasic signals on the left SFA and profunda. Hemostasis was
complete. There had been required one interrupted suture on the inflow for
hemostatic control. Fibrillar was used. The groins were then closed in
multiple layers using 2-0 and 3-0 Vicryl suture followed by subcuticular
stitches. Benzoin and Steri-Strips were applied. The patient tolerated this
procedure. No complications were noted.
Thanks for any guidance on this one!
