pfilson
Guest
Hello,
We are brand new to vascular coding and would very much appreciate any feedback on the attached operative report. The codes we have so far are I70.229 and I73.9. CPT 35371, 35372, 75635, EVAR code(s)?.
Thank you very much for any assistance provided.
Pam
PREOPERATIVE DIAGNOSES:
Acute ischemia of left leg with threatened limb, peripheral vascular disease.
POSTOPERATIVE DIAGNOSES:
Acute ischemia of left leg with threatened limb, peripheral vascular disease.
PROCEDURE PERFORMED:
Left femoral artery exploration with endarterectomy of the external iliac, common femoral, profunda femoris and SFA, patch angioplasty with profundoplasty using a bovine pericardial patch, aortogram with pelvic runoff, aortoiliac stent graft (EVAR) with extension of stent grafts on the left side down to the distal external iliac artery, right common iliac artery angioplasty with stent placement using a VBX stent graft placement of an 11 x 39 VBX stent graft in the distal infrarenal aorta, radiographic supervision and interpretation, closure of right femoral access using a star Close device.
ESTIMATED BLOOD LOSS: 100 mL.
ANESTHESIA: General.
CONDITION AT THE END OF THE CASE: Stable.
INDICATIONS:
This is who has a history of 2 strokes in 2017 and has since then not seen a physician. He presented today emergently to the ER with unbearable pain in his left foot with a clear ischemic changes and loss of function of his foot. A CTA identified extensive aortoiliac disease with high-grade narrowing of the distal aorta as well as bilateral iliac arteries. On the scan, it was also noticed that the left common femoral artery was occluded. There was reconstitution of a profunda femoris. We discussed thepr ocedure with the patient and his son and consent was obtained from the son as the patient has short-term memory loss.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and placed supine on the operating table. He was prepped and draped in standard surgical fashion, after which we proceeded to give appropriate antibiotics. General anesthesia had been instituted prior to this. We then approached his left groin. We made an oblique incision with a #10 blade. deepened the incision down to the deep fascia, which we opened longitudinally from underneath the inguinal ligament all the way down through the SFA. We also isolated all appropriate branches including the profunda femoris at both branching points. We also gained access and control of the lateral circumflex and the inferior epigastric and we were able to put our clamp into the external iliac above this.
We heparinized fully and then proceeded to clamp the profunda as well as the external iliac and branches, which had been *** with vessel loops. We proceeded to perform an arteriotomy wRh an 11 blade and extended this with Potts scissors, which was extremely challenging given the dense occlusion in the common fémoral artery. Nonetheless, we were able to extend our arteriotomy through the SFA and into the external iliac and then with the use of a Freer elevator, we were able to remove the plaque in its entirety and perform an eversion endarterectomy on the profunda femoris. We did then do a meticulous removal of debris in the•endarterectomy site and once satisfied, we brought our bovine pericardial patch onto the and sewed this into place using a running 6-0 Prolene suture. Prior to releasing all clamps, we backbled the profunda and forward flush the iliac artery. We then completed our patch and proceeded to gain ultrasound-guided access to the right common femoral artery using a micropuncture needle followed by advancement of the micropuncture wire and sheath. We upsized to a 7-French sheath over a Bentson wire, which we were with the aid of the diagnostic catheter, able to get up into the suprarenal aorta. In order to facilitate the treatment, we angioplasty the origin of the right common iliac with a 5 mm balloon as this was the smallest of the areas. From the left side, we had also puncture the patch and ultimately placed an
8-French sheath and through this sheath passed our 11 x 39 VBX, which was placed in the distal aorta, right down to the bifurcation point. This was dilated and subsequently brought up an 8 x 39 VBX and an 11 x 39 VBX right to the aortic stent and post-dilated these in order to recreate the aortic bifurcation in a CERAB configuration. We then focused our attention on the left iliac where the internal was found to be occluded. We therefore extended the VBX with a 7 x 7.5 Viabahn and followed by a 7 x 5 cm Viabahn. We extended this all the way down towards the inguinal ligament and thereafter had a good resolution of the high-grade stenoses in this segment. Satisfied this, we proceeded to remove our sheath and gain control by placing a 5-0 Prolene suture at the access point. It should be noted that we performed an aortogram with pelvic runoff at the outset, which showed extensive disease in the aorta and bilateral iliacs. A completion arteriogram showed good resolution of the stenosis in the stented segments, albeit there was residual stenosis distal to the right common iliac stent. Satisfied with our result, we proceeded to place a StarClose closure device on the right side and gained good control of the access point and then proceeded to reverse the heparin and gained meticulous hemostasis in the left groin. We then closed in layers with 2-0 PDS, 3-0 PDS, 4-0 Monocryl and Dermabond for the skin. At the end of the case, all sponge, needle and instrument counts were correct. The patient tolerated the procedure well and was transferred to the ICU in stable condition
We are brand new to vascular coding and would very much appreciate any feedback on the attached operative report. The codes we have so far are I70.229 and I73.9. CPT 35371, 35372, 75635, EVAR code(s)?.
Thank you very much for any assistance provided.
Pam
PREOPERATIVE DIAGNOSES:
Acute ischemia of left leg with threatened limb, peripheral vascular disease.
POSTOPERATIVE DIAGNOSES:
Acute ischemia of left leg with threatened limb, peripheral vascular disease.
PROCEDURE PERFORMED:
Left femoral artery exploration with endarterectomy of the external iliac, common femoral, profunda femoris and SFA, patch angioplasty with profundoplasty using a bovine pericardial patch, aortogram with pelvic runoff, aortoiliac stent graft (EVAR) with extension of stent grafts on the left side down to the distal external iliac artery, right common iliac artery angioplasty with stent placement using a VBX stent graft placement of an 11 x 39 VBX stent graft in the distal infrarenal aorta, radiographic supervision and interpretation, closure of right femoral access using a star Close device.
ESTIMATED BLOOD LOSS: 100 mL.
ANESTHESIA: General.
CONDITION AT THE END OF THE CASE: Stable.
INDICATIONS:
This is who has a history of 2 strokes in 2017 and has since then not seen a physician. He presented today emergently to the ER with unbearable pain in his left foot with a clear ischemic changes and loss of function of his foot. A CTA identified extensive aortoiliac disease with high-grade narrowing of the distal aorta as well as bilateral iliac arteries. On the scan, it was also noticed that the left common femoral artery was occluded. There was reconstitution of a profunda femoris. We discussed thepr ocedure with the patient and his son and consent was obtained from the son as the patient has short-term memory loss.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and placed supine on the operating table. He was prepped and draped in standard surgical fashion, after which we proceeded to give appropriate antibiotics. General anesthesia had been instituted prior to this. We then approached his left groin. We made an oblique incision with a #10 blade. deepened the incision down to the deep fascia, which we opened longitudinally from underneath the inguinal ligament all the way down through the SFA. We also isolated all appropriate branches including the profunda femoris at both branching points. We also gained access and control of the lateral circumflex and the inferior epigastric and we were able to put our clamp into the external iliac above this.
We heparinized fully and then proceeded to clamp the profunda as well as the external iliac and branches, which had been *** with vessel loops. We proceeded to perform an arteriotomy wRh an 11 blade and extended this with Potts scissors, which was extremely challenging given the dense occlusion in the common fémoral artery. Nonetheless, we were able to extend our arteriotomy through the SFA and into the external iliac and then with the use of a Freer elevator, we were able to remove the plaque in its entirety and perform an eversion endarterectomy on the profunda femoris. We did then do a meticulous removal of debris in the•endarterectomy site and once satisfied, we brought our bovine pericardial patch onto the and sewed this into place using a running 6-0 Prolene suture. Prior to releasing all clamps, we backbled the profunda and forward flush the iliac artery. We then completed our patch and proceeded to gain ultrasound-guided access to the right common femoral artery using a micropuncture needle followed by advancement of the micropuncture wire and sheath. We upsized to a 7-French sheath over a Bentson wire, which we were with the aid of the diagnostic catheter, able to get up into the suprarenal aorta. In order to facilitate the treatment, we angioplasty the origin of the right common iliac with a 5 mm balloon as this was the smallest of the areas. From the left side, we had also puncture the patch and ultimately placed an
8-French sheath and through this sheath passed our 11 x 39 VBX, which was placed in the distal aorta, right down to the bifurcation point. This was dilated and subsequently brought up an 8 x 39 VBX and an 11 x 39 VBX right to the aortic stent and post-dilated these in order to recreate the aortic bifurcation in a CERAB configuration. We then focused our attention on the left iliac where the internal was found to be occluded. We therefore extended the VBX with a 7 x 7.5 Viabahn and followed by a 7 x 5 cm Viabahn. We extended this all the way down towards the inguinal ligament and thereafter had a good resolution of the high-grade stenoses in this segment. Satisfied this, we proceeded to remove our sheath and gain control by placing a 5-0 Prolene suture at the access point. It should be noted that we performed an aortogram with pelvic runoff at the outset, which showed extensive disease in the aorta and bilateral iliacs. A completion arteriogram showed good resolution of the stenosis in the stented segments, albeit there was residual stenosis distal to the right common iliac stent. Satisfied with our result, we proceeded to place a StarClose closure device on the right side and gained good control of the access point and then proceeded to reverse the heparin and gained meticulous hemostasis in the left groin. We then closed in layers with 2-0 PDS, 3-0 PDS, 4-0 Monocryl and Dermabond for the skin. At the end of the case, all sponge, needle and instrument counts were correct. The patient tolerated the procedure well and was transferred to the ICU in stable condition