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i need help with coding this procedure:
1) left superficial femoral artery endarterectomy with pericardial patch angioplasty
2) resection of left common femoral artery anastomotic pseudoaneurysm
3) redo left groin dissection (?)
"the previous incision laterally was opened obliquely in line with the prior incision. this was extended inferiorly across the groin crease. abundant subcutaneous tissue was divided. we encountered a large oblong mass just anterior to the left common femoral artery. this appeared to be thrombosed pseudoaneurysm. of note is on the preop ct angiogram, there was a fluid-filled collection noted, which was suspected to be a sermona. this coincided with the location of that lesion. it appeared to be obviously a thrombosed pseudoaneurysm with no evidence obviously of infection.
we went up to the inguinal ligament, got control of the aortofemoral graft limb uneventfully as well as the common femoral artery. distally, the superficial femoral artery below the calcified plaque in the proximal SFA was controlled circumferentially as was the profunda femoris artery. the patient was heparinized with 10,000 units IV.
after allowing heparin circulation time, the vessels were sequentially occluded. i basically amputated the pedunculated stalk of the pseudoaneurysm. again, this was thrombosed. it came off of the toe of the anastomosis.
i was uncertain as to whether or not this groin had been punctured since the graft was placed, possibly for cardiac catherization. that might have been another potential source. in any event, the aneurysm sac was resected uneventfully as well as a thrombus within it. no purulent materal was identified. we extended the arteriotomy proximally and distally and debrided the distal most aspect of the analysis of the graft anastomosis. this extended it down to the proximal SFA through heavily diseased calcified plaque and into relatively normal-appearing artery.
we did an endarterectomy of the proximal SFA over a length of about 3.5 to 4 cm. this was done in the subadventitial plane with a freer elevator. backbleeding was present from the distal segment. we preserved the origin of the profunda. no distal flap elevation was identified.
we used a pericardial carotid patch to close the arteriotomy. that was was sewn with running 5-0 prolene suture from either end."
so far i have:
35141
35371-51.
that's it. i know there's more to it but i could not figure out the 'redo left groin dissection'.
please help. thanks
1) left superficial femoral artery endarterectomy with pericardial patch angioplasty
2) resection of left common femoral artery anastomotic pseudoaneurysm
3) redo left groin dissection (?)
"the previous incision laterally was opened obliquely in line with the prior incision. this was extended inferiorly across the groin crease. abundant subcutaneous tissue was divided. we encountered a large oblong mass just anterior to the left common femoral artery. this appeared to be thrombosed pseudoaneurysm. of note is on the preop ct angiogram, there was a fluid-filled collection noted, which was suspected to be a sermona. this coincided with the location of that lesion. it appeared to be obviously a thrombosed pseudoaneurysm with no evidence obviously of infection.
we went up to the inguinal ligament, got control of the aortofemoral graft limb uneventfully as well as the common femoral artery. distally, the superficial femoral artery below the calcified plaque in the proximal SFA was controlled circumferentially as was the profunda femoris artery. the patient was heparinized with 10,000 units IV.
after allowing heparin circulation time, the vessels were sequentially occluded. i basically amputated the pedunculated stalk of the pseudoaneurysm. again, this was thrombosed. it came off of the toe of the anastomosis.
i was uncertain as to whether or not this groin had been punctured since the graft was placed, possibly for cardiac catherization. that might have been another potential source. in any event, the aneurysm sac was resected uneventfully as well as a thrombus within it. no purulent materal was identified. we extended the arteriotomy proximally and distally and debrided the distal most aspect of the analysis of the graft anastomosis. this extended it down to the proximal SFA through heavily diseased calcified plaque and into relatively normal-appearing artery.
we did an endarterectomy of the proximal SFA over a length of about 3.5 to 4 cm. this was done in the subadventitial plane with a freer elevator. backbleeding was present from the distal segment. we preserved the origin of the profunda. no distal flap elevation was identified.
we used a pericardial carotid patch to close the arteriotomy. that was was sewn with running 5-0 prolene suture from either end."
so far i have:
35141
35371-51.
that's it. i know there's more to it but i could not figure out the 'redo left groin dissection'.
please help. thanks