debksmith1
New
I am having a hard time finding information on the following scenario;
Preoperative Diagnosis: Occluded right external iliac artery
Postoperative Diagnosis: Same
Indications for Operation: This is a 59-year-old white man who has undergone attempted right iliac balloon angioplasty approximately two weeks prior to this admission. We were unable to open the right external iliac artery and at this point in time, the patient presents for an elective femoral bypass graft.
Operation: The patient was taken to the operating room and placed in the supine position. Once adequate epidural anesthesia had been obtained, the patient’s lower abdomen and bilateral lower extremities were prepared and draped in the usual fashion. Incisions were made in both groins simultaneously and each common femoral and superficial femoral artery was approached using blunt dissection to the subcutaneous tissue. The common femoral artery, superficial femoral artery, and smaller arteries were then identified and isolated with ligaloops. On the left side, the common femoral artery and superficial femoral artery were palpated and noted to have an arteriosclerotic plaque posteriorly, but a soft anterior area of the artery proximal. This point was chosen for the anastomotic site. The patient was then heparinized, and after waiting an appropriate amount of time, a 1.5-cm arteriotomy was then made.
The prosthetic graft was then chosen to be a ringed Gore-Tex 8 suture. A tunnel was then created from the right groin to the left through the tissue and over to the right groin. The right common femoral artery was then examined and noted to have plaque posteriorly, but was soft anteriorly. Approximately 1 to 1.5-cm arteriotomy was then made. The graft that was previously brought through the groin was then sized and the anastomosis was begun. A running #6-0 Prolene suture was used. As the anastomosis was completed, the left leg was opened and the graft was flushed to remove any clots. As distal control was released on the right superficial femoral artery, back bleeding was noted to be poor; therefore, a thrombectomy was performed using a 4-mm Fogarty catheter. Repeat back bleeding revealed good patency of the artery. The anastomosis was then completed. All ligaloops were then removed and there was noted to be good flow through both the graft and the right lower extremity with good Doppler pulses. The groin incisions were then closed in two layers and the skin was closed with interrupted nylon suture. Dressings were placed and the patient was removed from the operating room in stable condition.
It was coded as 35661, 34201-51, is this correct or is the thrombectomy included in the bypass graft and why or why not? I appreciate any help anyone can give me.
Preoperative Diagnosis: Occluded right external iliac artery
Postoperative Diagnosis: Same
Indications for Operation: This is a 59-year-old white man who has undergone attempted right iliac balloon angioplasty approximately two weeks prior to this admission. We were unable to open the right external iliac artery and at this point in time, the patient presents for an elective femoral bypass graft.
Operation: The patient was taken to the operating room and placed in the supine position. Once adequate epidural anesthesia had been obtained, the patient’s lower abdomen and bilateral lower extremities were prepared and draped in the usual fashion. Incisions were made in both groins simultaneously and each common femoral and superficial femoral artery was approached using blunt dissection to the subcutaneous tissue. The common femoral artery, superficial femoral artery, and smaller arteries were then identified and isolated with ligaloops. On the left side, the common femoral artery and superficial femoral artery were palpated and noted to have an arteriosclerotic plaque posteriorly, but a soft anterior area of the artery proximal. This point was chosen for the anastomotic site. The patient was then heparinized, and after waiting an appropriate amount of time, a 1.5-cm arteriotomy was then made.
The prosthetic graft was then chosen to be a ringed Gore-Tex 8 suture. A tunnel was then created from the right groin to the left through the tissue and over to the right groin. The right common femoral artery was then examined and noted to have plaque posteriorly, but was soft anteriorly. Approximately 1 to 1.5-cm arteriotomy was then made. The graft that was previously brought through the groin was then sized and the anastomosis was begun. A running #6-0 Prolene suture was used. As the anastomosis was completed, the left leg was opened and the graft was flushed to remove any clots. As distal control was released on the right superficial femoral artery, back bleeding was noted to be poor; therefore, a thrombectomy was performed using a 4-mm Fogarty catheter. Repeat back bleeding revealed good patency of the artery. The anastomosis was then completed. All ligaloops were then removed and there was noted to be good flow through both the graft and the right lower extremity with good Doppler pulses. The groin incisions were then closed in two layers and the skin was closed with interrupted nylon suture. Dressings were placed and the patient was removed from the operating room in stable condition.
It was coded as 35661, 34201-51, is this correct or is the thrombectomy included in the bypass graft and why or why not? I appreciate any help anyone can give me.