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Vein mapping and ultrasound guideance

  1. #1
    Unhappy Vein mapping and ultrasound guideance
    Medical Coding Books
    We have a new physician and he is doing a procedure we have never seen before. Can someone please help us with this?

    Here is the note:
    PREOPERATIVE DIAGNOSIS:
    Right popliteal aneurysm.

    POSTOPERATIVE DIAGNOSIS:
    Right popliteal aneurysm.

    PRIMARY PROCEDURES:
    1. Right femoral artery exploration and repair.
    2. Ultrasound guidance of lower extremity ultrasound vein mapping and arterial mapping.
    3. Angiogram right lower extremity.


    INDICATIONS:
    The patient is an 87-year-old male who was found to have a right popliteal aneurysm and AAA. This was fixed open, the AAA, a few months ago. The patient has continued to complain of a right knee bulging and pulsatile mass. His information was sent to the ____ company and a Viabahn stent was recommended to be placed. After all risks and benefits were explained to the patient including infection, bleeding, sepsis, death, recurrence, injury to the vessels, amputation, and ischemia, informed consent was obtained. Please see chart for the consent.

    GROSS PATHOLOGY:
    On shooting the angiogram, there appeared to be very poor flow throughout his lower extremity. The blood, however, did go through the aneurysm and then there was complete loss of the popliteal with reconstitution to two-vessel runoff. The rep and the surgeon and the assistant were in agreement that the Viabahn stent should not be deployed due to the very poor runoff and the risk of causing ischemia to the lower extremity.

    PROCEDURE IN DETAIL:
    The patient was brought to the operative suite, prepped and draped in normal sterile fashion. Appropriate anesthesia given per the Anesthesia Department.

    Prophylactic antibiotics were given by the Anesthesia Department. Next, an incision was made over the right femoral area after ultrasound guidance was performed. Once this was done, we then exposed the common, superficial, and deep femoral arteries. Heparin was then given. We then placed a pursestring around the common femoral with 5-0 Prolene. We then placed a mini stick needle through this guidewire under fluoroscopy. We then shot angiograms with the above pathology. We then aborted the original procedure, removed the catheters, and protamine was given to reverse the heparin. We then sutured the artery with multiple 5-0 Prolenes. Good pulses were obtained intraoperatively proximal and distal to this. Multiple layers of Vicryl and nylon were used to close the skin and soft tissue.




    Would the angiogram be the only thing billed for? We have no idea any ideas would be greatly appreiciated!!!

    Lisa

  2. #2
    Location
    Richardson, TX
    Posts
    823
    Default
    I'd say 35226. He talks about an aneurysm and the dictation reflects a direct repair, to me. I didn't go with 35151 because the documentation is somewhat vague, and, CPT 35151 includes graft insertion, but I didn't see that documented. It seemed like a direct repair to me.
    Julie Graham, BA, CPC, CCC

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