One more try... thoracic aorta endovascular repair

claning

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Hello! putting this out there once more, thanks!!

I need some help with the following report, the Dr sent 34713/50, 36200/50, 33880 (75956), 37252, & 33889. I see 34713, 34812, 36200/50, 33880 (75956), 37252, 37253. I'm not familiar enough with these procedures to be sure there is no 33889 documented (or 2nd 34713) Any help or tips you have for me is greatly appreciated! thanks, Carol

EXAMINATION: IR THORACIC AORTA ENDOVASCULAR REPAIR WITH SUBCLAVIAN COVERAGE
DATE/TIME: 6/4/2019 9:00 PM

HISTORY: Acute onset chest pain with Stanford type B aortic dissection. Uncontrolled hypertension despite multiple IV medications.

COMPARISON: CT scan 6/4/2019 and 6/2/2019 SURGEONS:

PRE-OPERATIVE DIAGNOSIS: Stanford Type B aortic dissection POST-OPERATIVE DIAGNOSIS: Same ESTIMATED BLOOD LOSS: 160)cc.

ANESTHESIA: General anesthesia.

TECHNIQUE: Informed consent was obtained. Patient was brought to the operative suite. Both groins, abdomen and chest were prepped and draped using maximal sterile technique. Dr. Yang performed a left common carotid to left subclavian bypass graft. Please see separately dictated report for further description of this procedure. Real-time ultrasonography was used to evaluate both common femoral arteries. Small dermal incisions were then made over both common femoral arteries. Using real-time ultrasonographic guidance micropuncture sets were then used to access both common femoral arteries. Via the left access site a 6 French vascular sheath was placed. Via the right access sheath two Perclose sutures were successfully placed. This was followed by placement of a 9 French vascular sheath. A 5 French angled catheter and Glidewire were then advanced via the right access sheath. The catheter was removed and a 9 F IVUS catheter was advanced over the guidewire to confirm intraluminal position within the true lumen of the dissection. Real-time intravascular ultrasound was then performed. True lumen positioning was noted throughout the abdominal and thoracic aorta. A double lumen Lunderquist wire was then placed within the ascending thoracic aorta. Via the left access sheath a marking pigtail catheter was advanced over a guidewire into the ascending thoracic aorta. Patient was then given additional 3000 units heparin intravenously. A 16 French dilator was advanced over the right femoral access site. This was followed by placement of a Medtronics Valiant Navion thoracic stent graft measuring 37 x 37 x 223 which was advanced into the level of the aortic arch. Angiography via the pigtail catheter was then performed. Using roadmap angiography the stent graft was successfully deployed with the fabric portion positioned just distal to the left common carotid artery.. The pigtail catheter was then retracted over a guidewire and then readvanced through the newly placed stent. Post stent graft angiography was obtained. The IVUS catheter was then readvanced and repeat real-time intravascular ultrasonography performed. The delivery system was removed and a 16 French vascular sheath placed at the access site. The vascular sheath was then removed over a guidewire and both Perclose sutures tightened. Hemostasis was achieved. A Star close device was placed at the left femoral access site. 4-0 Vicryl suture was then used to close the small dermatotomy within the right groin. Dermabond was placed on the skin of both access sites. Sterile dressings were applied. ANGIOGRAPHIC

FINDINGS: The right common femoral artery is patent without significant atherosclerosis or evidence of dissection. Intravascular ultrasonography reveals a type B aortic dissection extending to the level of the aortoiliac bifurcation. Intraluminal positioning was noted throughout the thoracic and abdominal aorta. Thoracic aortic angiography reveals anomalous origin of the left vertebral artery via the thoracic aorta. Pronounced filling of the false lumen with contrast involving the proximal descending thoracic aorta is noted. Post stent graft images reveal a well positioned graft with the fabric portion positioned distal to the left common carotid artery. The innominate and common carotids remain widely patent. Patent carotid to subclavian bypass graft is partially visualized. No evidence of persistent contrast opacification of the false lumen within the proximal descending thoracic aorta. Repeat IVUS imaging reveals improved size of the compressed true lumen by the stent graft when compared with pre stent graft imaging.. IVUS imaging of the abdomen reveals filling of the celiac, SMA, left renal, and IMA via the false lumen. No evidence of dissection extending into these vessels. The right renal artery origin appears to originate from the true lumen however the dissection flap is in close proximity to the origin of this vessel.

COMPLICATIONS: None.

BILLING CODES: -34713-50-62, 36200-50, 33880-62, 75956-26, 37252-62, 33889-62

IMPRESSION: Successful endovascular repair of a Stanford type B aortic dissection using the Medtronics Valiant Navion Stent Graft.
 

ellis3350

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Okay, I'm going to say 33880, 33889, 75956,26, 34812,RT, 36200,50, 37252. The left access sheath was smaller than a 12 for coding guidelines and the left didn't feel like an open access. If the provider is saying 34713 then he/she doesn't think either side was a cutdown and in that case query or go with 34713,RT and still nothing for the left.
 
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