Maricela123@gmail.com
Contributor
I need some help coding the following case. Here is the scenario:
PRE-OPERATIVE DIAGNOSIS:
Bleeding from ruptured arteriovenous fistula aneurysm
POST-OPERATIVE DIAGNOSIS:
Same
INDICATIONS FOR PROCEDURE:
This is a 54-year-old male who required emergency surgery for brisk pulsatile bleeding from a ruptured arteriovenous fistula aneurysm.
DESCRIPTION OF PROCEDURE(S):
Immediately after the patient was brought into the OR, a preinduction checklist was performed. Anesthesia was induced and the patient was intubated without issue. The patient had two CAT tourniquets which we removed and immediately encountered brisk pulsatile bleeding from the site of aneurysm rupture. The bleeding was controlled with finger pressure while the entire left arm was prepared with Betadine. The surgical site was then draped in a sterile fashion and the pneumatic tourniquet was applied. While maintaining finger pressure at the bleeding site, an incision was made medial to the site of the bleeding. The incision was carried down to the arteriovenous fistula and ultimately connected to the skin area that had been opened by the ruptured aneurysm. At this point we heparinized the patient with 5000 units of heparin IV and inflated the tourniquet to 300 mmHg. We then continued our dissection around the dome of the aneurysm until healthy vessel walls were encountered. After we obtained control of the bleeding vascular surgery was consulted intraop but they were not available at the time and they recommended closing the aneurysm with prolene. At this point, using Metzenbaum scissors, we excised the ruptured dome of the aneurysm. The remaining wall of the aneurysm was closed with a 4-0 Prolene running suture. The tourniquet was deflated and insufflated a total of 3 times to allow for flushing of any potential thrombus first distally and then proximally prior to completing the aneurysmorrhaphy. The skin was then approximated with 3-0 Nylon. Triphasic signals of the radial and ulnar arteries were verified with a Doppler probe. Complete counts were verified with the OR staff. The patient was transferred to PACU in a stable condition.
The tourniquet total time was less than 2 hours, and we decided not to do a fasciotomy release at that time. We will monitor compartments closely.
I am looking at cpt 35206 repair of blood vessel othen than for fistula, with or without patch angioplasty.
PRE-OPERATIVE DIAGNOSIS:
Bleeding from ruptured arteriovenous fistula aneurysm
POST-OPERATIVE DIAGNOSIS:
Same
INDICATIONS FOR PROCEDURE:
This is a 54-year-old male who required emergency surgery for brisk pulsatile bleeding from a ruptured arteriovenous fistula aneurysm.
DESCRIPTION OF PROCEDURE(S):
Immediately after the patient was brought into the OR, a preinduction checklist was performed. Anesthesia was induced and the patient was intubated without issue. The patient had two CAT tourniquets which we removed and immediately encountered brisk pulsatile bleeding from the site of aneurysm rupture. The bleeding was controlled with finger pressure while the entire left arm was prepared with Betadine. The surgical site was then draped in a sterile fashion and the pneumatic tourniquet was applied. While maintaining finger pressure at the bleeding site, an incision was made medial to the site of the bleeding. The incision was carried down to the arteriovenous fistula and ultimately connected to the skin area that had been opened by the ruptured aneurysm. At this point we heparinized the patient with 5000 units of heparin IV and inflated the tourniquet to 300 mmHg. We then continued our dissection around the dome of the aneurysm until healthy vessel walls were encountered. After we obtained control of the bleeding vascular surgery was consulted intraop but they were not available at the time and they recommended closing the aneurysm with prolene. At this point, using Metzenbaum scissors, we excised the ruptured dome of the aneurysm. The remaining wall of the aneurysm was closed with a 4-0 Prolene running suture. The tourniquet was deflated and insufflated a total of 3 times to allow for flushing of any potential thrombus first distally and then proximally prior to completing the aneurysmorrhaphy. The skin was then approximated with 3-0 Nylon. Triphasic signals of the radial and ulnar arteries were verified with a Doppler probe. Complete counts were verified with the OR staff. The patient was transferred to PACU in a stable condition.
The tourniquet total time was less than 2 hours, and we decided not to do a fasciotomy release at that time. We will monitor compartments closely.
I am looking at cpt 35206 repair of blood vessel othen than for fistula, with or without patch angioplasty.