Wiki Transcatheter aortic valve replacement. Via alternative access with Carotid cutdown

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I am stumped on how to code this and was hoping to get some help. I know how to code the regular TAVR with the femoral approach but this was done with a Carotid Cut down approach . Any help is greatly appreciated.

TAVR EDWARDS Sapien 3 Operative Note Date of Operation: 10/7/2022 Pre-Operative Diagnosis: Severe symptomatic aortic stenosis. Major Comorbidities and Complications: Patient didn't qualify NYHA Class: Class IV Post-Operative Diagnosis: Severe symptomatic aortic stenosis status post transcatheter aortic valve replacement. Title of Procedure: Transcatheter aortic valve replacement. Via alternative access with Carotid cutdown (Co-Surgeon- Interventional Cardiology): Co Surgeon- Vascular Surgery): (Co-Surgeon- Cardiothoracic Surgery): - Assisting (Cardiac Anesthesiologist /Transesophageal Echocardiographer): Assisting Interventional Cardiologists: none Brief History: The patient is an 76 y.o. female with severe symptomatic aortic stenosis. After careful evaluation by Valve Team, the patient was felt to be an appropriate candidate for transcatheter aortic valve replacement with an Edwards SAPIEN 3 23 (+1) mm valve. Procedure: Main Device Access site (R/L): Left Common Cartid Artery cutdown femoral artery, 14 French Edwards sheath Temporary Pacemaker Access site (R/L): R femoral vein, 5 French sheath Additional Arterial Access (R/L): R femoral artery, 7 French sheath Additional arterial access: Not used The patient was brought to the Hybrid OR Lab in fasting status. Anesthesia, central venous access and was performed by the cardiac anesthesiology team. The patient was prepped and draped in a sterile fashion. The first timeout was performed. Dr. he exposed and accessed the left common carotid artery and placed a 6 French sheath. Please see details of his portion of the procedure separately dictated 2% lidocaine was used to infiltrate the skin and subcutaneous tissue overlying the Right femoral artery. Utilizing fultrasound guidance, percutaneous access was obtained in the common femoral artery . Over O35 wire we then placed a 30 cm 7 French sheath. Percutaneous access was then obtained in the common femoral vein adjacent to the 7 French sheath with placement of a 5 French venous sheath. A 5-French BARD balloon flotation temporary pacer was advanced through the venous sheath and carefully positioned under fluoroscopic guidance in the right ventricle. The pacemaker was tested and then secured in position. Through the 6 French sheath in the carotid artery, we advanced a J-wire and an AL-1 catheter to the aortic valve. I then carefully crossed the valve with a Newton wire and advanced the AL-1 catheter into the left ventricle. I then exchanged the catheter for a pigtail catheter. Through the pigtail catheter, an Amplatz Super Stiff wire with a protective loop was advanced to the LV apex.. A second timeout was performed. We then exchanged the 6 French sheath for the 14 French delivery sheath. This was advanced to the aortic valve and then the dilator removed.Meanwhile, a 23 mm Sapien S3 valve was prepped and crimped over the delivery system. Valve orientation was confirmed. The valve was then slowly advanced under fluoroscopy guidance and positioned across the native valve. Using rapid pacing at 160 beats per minute the valve was then slowly deployed and balloon was fully inflated for 5 seconds. Ascending aortography was performed to assess position and paravalvular aortic insufficiency. Aortography was repeated. Aortic insufficiency was reduced to trace/mild. The delivery system was Removed and Dr performed closure of the carotid arteriotomy and overlying tissues and planes A Perclose ProGlide was used to close the 7 Fr common femoral arteriotomy, But the suture broke. I therefore deployed an 8 French Angio-Seal with adequate achievement of hemostasis Heparin was used for anticoagulation, ACT was monitored during the procedure, and was reversed with protamine at the end of the case. The patient remained hemodynamically stable throughout the procedure and left the cardiac catheterization room in stable condition to CVICU. Complications: None Estimated Blood Loss: 200 cc Impression: Successful transcatheter aortic valve replacement using a 23 (+1 cc) mm Sapien S3 valve through a Left common carotid artery access point Implant Name Type Inv. Item Serial No. Manufacturer Lot No. LRB No. Used Action SYSTEM SAPIEN3 ULTRA VALVE 23M EDWARDS LIFESCIENCES (BAXTER) Left 1