Wiki Impella insert via RT subclavian art. via 10mm hemoshield chimney graft

miclana89

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We would appreciate some assistance in this Impella insertion case.

Surgeon made an infraclavicular incision and carried the dissection down through the subcutaneous tissues, divided the pectoralis muscle and carried down into the subclavian artery.
Once the vessel loops were tightened, an arteriotomy was made and a hemostatic valve was placed on the hemoshield graft and the Impella was placed, under fluoroscopic guidance, through the aortic valve into the left ventricle.

The surgeon coded 33975, but the requirements were not met as patient was not placed under CP Bypass.

Would 33990, +34716 be applicable or is the dissection to subclavian not covered under the "cutdown"?
 
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