TnRushFan
Guru
Good morning folks...I think I am in over my head...LOL. Our senior surgery coder retired and now these are falling onto me...
I have searched and cannot find a code for stenting an already existing occluded graft, any guidance will be greatly appreciated.
POSTOPERATIVE DIAGNOSIS: Occluded left limb of aortic bifemoral bypass.
PROCEDURE:
1. Left femoral groin exploration, left iliac graft thrombectomy,
interposition end-to-end bypass graft with Gore-Tex from left iliac
prosthetic limb to native left common femoral artery. 37881-lt?
2. Aortogram. bundle?
3. Right groin cutdown and right iliac graft thrombectomy. 35876-rt?
4. Left iliac graft stent placement x2 (Viabahn VBX 8 x 79 mm). ? ? ? ?
5. Left femoral to below knee popliteal bypass with in situ greater
saphenous vein. 35583-lt
** complete thrombosis of the left limb of his aorto bifemoral graft
**left transverse longitudinal groin incision and left femoral groin exploration.
** graft was opened and excess prosthetic removed using sharp dissection
**did an open graft thrombectomy
**did a thrombectomy of the profunda and SFA
**attention to the common femoral artery and again
trimmed and removed any excess graft
**there was approximately a gap of about 4 cm. We bridged this gap using a interposition piece of Gore-Tex graft.
**performed an end-to-end interposition bypass using
Gore-Tex suture from this left iliac prosthetic limb to the native left common femoral artery.
**image that demonstrated good flow from the
aorta into the left common iliac; however,the right common iliac did not fill briskly.
**several attempts to pass over the bifurcation
**after several attempts we were not able to cannulate the right common iliac artery through the prosthetic graft
----concerned that during the graft thrombectomy, we had inadvertently embolized some thrombus
**did a direct cutdown on the right femoral artery
** longitudinal incision directly over the right
femoral artery pulse and cutdown to identify the distal end of the right iliac limb
** made a transverse arteriotomy
**introduced a 4-French Fogarty into the graft and via several passes we were able to evacuate all clot
**left common iliac and elected to place two 8 x 79 mm Viabahn stents…balloon expandable stent…placed a second stent with a small amount of overlap and again this was inflated
**attention to the left femoral to below knee popliteal bypass.
**anastomosis between the in situ vein graft
**performed a running anastomosis
**attention to the lower leg to identify the below knee popliteal.
**valvulotome up into the vein and attempted to lyse all the valves
**valvulotome through this branch and we were able to identify and lyse one additional remaining valve
**placed an incisional wound VAC over all incisions
I have searched and cannot find a code for stenting an already existing occluded graft, any guidance will be greatly appreciated.
POSTOPERATIVE DIAGNOSIS: Occluded left limb of aortic bifemoral bypass.
PROCEDURE:
1. Left femoral groin exploration, left iliac graft thrombectomy,
interposition end-to-end bypass graft with Gore-Tex from left iliac
prosthetic limb to native left common femoral artery. 37881-lt?
2. Aortogram. bundle?
3. Right groin cutdown and right iliac graft thrombectomy. 35876-rt?
4. Left iliac graft stent placement x2 (Viabahn VBX 8 x 79 mm). ? ? ? ?
5. Left femoral to below knee popliteal bypass with in situ greater
saphenous vein. 35583-lt
** complete thrombosis of the left limb of his aorto bifemoral graft
**left transverse longitudinal groin incision and left femoral groin exploration.
** graft was opened and excess prosthetic removed using sharp dissection
**did an open graft thrombectomy
**did a thrombectomy of the profunda and SFA
**attention to the common femoral artery and again
trimmed and removed any excess graft
**there was approximately a gap of about 4 cm. We bridged this gap using a interposition piece of Gore-Tex graft.
**performed an end-to-end interposition bypass using
Gore-Tex suture from this left iliac prosthetic limb to the native left common femoral artery.
**image that demonstrated good flow from the
aorta into the left common iliac; however,the right common iliac did not fill briskly.
**several attempts to pass over the bifurcation
**after several attempts we were not able to cannulate the right common iliac artery through the prosthetic graft
----concerned that during the graft thrombectomy, we had inadvertently embolized some thrombus
**did a direct cutdown on the right femoral artery
** longitudinal incision directly over the right
femoral artery pulse and cutdown to identify the distal end of the right iliac limb
** made a transverse arteriotomy
**introduced a 4-French Fogarty into the graft and via several passes we were able to evacuate all clot
**left common iliac and elected to place two 8 x 79 mm Viabahn stents…balloon expandable stent…placed a second stent with a small amount of overlap and again this was inflated
**attention to the left femoral to below knee popliteal bypass.
**anastomosis between the in situ vein graft
**performed a running anastomosis
**attention to the lower leg to identify the below knee popliteal.
**valvulotome up into the vein and attempted to lyse all the valves
**valvulotome through this branch and we were able to identify and lyse one additional remaining valve
**placed an incisional wound VAC over all incisions
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