Help with correct codes for this vascular surgery

jdibble

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I'm looking for some help with this surgery...vascular procedures confuse me! I have looked at codes 34203, 35302 & 35666 for the vascular surgery. I am not sure if I am looking at the right codes or if the documentation is clear as to the areas.

If I could get some answers, as well as some pointers on how to determine the correct codes it would be greatly appreciated!!

Procedure in detail: The patient was taken urgently to the operating room and after the induction of satisfactory general LMA anesthesia prepped and draped in the usual sterile fashion in the supine position over the left leg. Initially, a cutdown was performed below the knee on the medial aspect over the saphenous vein, which appeared of reasonable size on a previous ultrasound and carried down to subcutaneous tissues where a very small, sclerotic saphenous vein was in countered. The fascia was then incised and the posterior muscle swept anteriorly ext opposing the distal popliteal artery and carefully D dissecting down along the neurovascular bundle, taking small crossing veins with Ligaclips exposing the trifurcation. There was obvious clot within the trifurcation vessels and the popliteal artery. The femoral cutdown was then performed in the usual fashion with a linear incision controlling hemostasis with the Bovie cautery, and ligated in lymphatics between 2 and 3 0 Vicryl ties until the common femoral, profundus femoris and superficial femoral arteries with her branches were exposed and controlled with vessel loops. The saphenous vein was also observed here and once again was quite small and inadequate for in situ bypass. Lower in the leg the saphenous vein was also exposed down to the level of the ankle and although this was slightly larger there was inadequate length to even bring it above the knee. At this point the patient was systemically heparinized and a linear incision was created over the trifurcation vessels and directed thrombectomy was performed with a significant amount of clot returned. After multiple passages of the 3. Fogarty thrombectomy catheter, bright red blood was retrieved and of further clot was evident. Heparin irrigation was placed down the anterior tibial and posterior tibial arteries and the branches controlled with Yasergil clips. Proximal thrombectomy was also performed an although we were able to get up to the level of the femoral artery where there was a pulse multiple pull-through cyst revealed no evidence of flow. At this point it was decided that the only option was a PTFE graft and a 6 millimeter reinforced graft was selected. After spatula eating the graft, an end-to-side anastomosis was created between the arteriotomy at the level of the trifurcation with a continuous 6 0 Prolene suture. A subsartorial tunnel was created and the graft pulled back through into the femoral incision. Arteriography was performed showing a patent anastomosis with runoff down both vessels to the level of the foot. The proximal artery was then controlled with atraumatic vascular clamps and an anterior arteriotomy measuring approximately 2 and 0.5 centimeters was performed. There was a significant amount of calcific plaque in the posterior portion the artery in endarterectomy was performed with the Freer elevator. This was irrigated aspirated and particulate matter was completely removed. After spatula eating the proximal graft an end-to-side anastomosis was created with a continuous 5 0 Prolene suture. This was 1st opened into the superficial femoral artery and then into the from the and the graft. There was a palpable pulse in the distal graft and the vessels just below this. There was an excellent, biphasic to triphasic Doppler signal. A biphasic Doppler signal was also found at the posterior tibial artery at the ankle. Hemostasis was controlled with the thrombin anticoagulant 2 large Jackson-Pratt drains were placed in the upper lower incisions and secured with silk sutures. The wounds were closed with continuous 2 and 3 0 Vicryl sutures for the deep and subcutaneous tissues and a surgical stapling device for the skin.
Attention was then turned to the right below-knee amputation that had been traumatically opened in a fall. This was prepped and draped with Betadine and 3, 3 0 Prolene sutures were used to partially coapted the skin. Bacitracin ointment and sterile dressings were placed on the incisions. Occlusive bandages were placed on the left leg. The patient tolerated the procedure satisfactorily and returned to recovery in stable condition with all final

Thanks for all and any help!! :eek:

Jodi
 
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