Help!! :) Removal of residual remnants of LT Axillofemoral bypass graft x2


Keystone Heights, FL
Best answers
I am needing some help with coding this report below:

Pt presented several years ago w/infected left CFA. She has undergone multiple revascularizations after ligation of her groin vessels over the past several years. This resulted in a recent above-knee amputation. She has a segment of residual axillofemoral graft in the left axilla, which causes her pain especially when using her wheelchair. She also complains of pain along the course of an axillofemoral graft that runs down the left anterior chest wall to the groin. She presents today for removal of these residual grafts.

Procedure in Detail:
The patient was brought to the operating room and placed on the operating table in supine position. A general anesthetic was administered. She was prepped and draped in usual sterile fashion. I reopened the longitudinal incision in the infraclavicular position of the left upper chest. Through this approach, the axillofemoral graft the ran down the anterior chest wall was identified and mobilized. We mobilized it up nearly to the anastomosis to the subclavian artery. The graft was well incorporated with no sign of infection. I felt that complete removal of the subclavian artey and patch angioplasty was unnecessary, especially in light of risk of arterial injury and brachial plexus injury. I left a small remnant of the graft in place, divided the graft transversely and double oversewed the proximal stump with a double layer of HS-7 Prolene suture. Then through several small transverse incisions along the course of the graft in the left anterior chest wall going down to the groin, I mobilized the graft through each of these incisions and then removed the graft in its entirety. The graft was well incorporated throughout its course with no sign of infection. The wounds were irrigated with copious amounts of antibiotic solution and closed with 3-0 Vicryl suture and skin staples. We then identified the distal aspect of an old axillofemoral graft that was lateral to the breast. I reopened an old transverse incision where the graft had been transected in the past. I identified and mobilized the distal aspect of the graft and then mobilized it proximally till I reached the cut end. This remnant of graft was removed in its entirety as well. Again, this incision was closed similarly with a running 3-0 Vicryl suture and skin staples. Dry dressings were applied. The patient tolerated the procedure well and was transferred to the recovery room in stable condition.

I'm just not sure how this should be coded because there was no infection so it wouldn't be the 35905 CPT correct??

Thanks so much in advance!

Heather, CCC