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Another vein mapping

  1. #1
    Unhappy Another vein mapping
    Medical Coding Books
    We have a new physician and he is doing the following procedure. We have the code for the Endovascular aortic repair but don't know how to code the rest of the note. Here is the note.

    OPERATION:
    1. Ultrasound mapping of the lower extremities bilaterally.
    2. Bilateral femoral artery exposure and repair.
    3. Endovascular aortic repair of abdominal aortic aneurysm -

    INDICATIONS:
    The patient is a male who was found to have abdominal aortic aneurysm. After all risks and benefits were explained to him including infection, bleeding, sepsis, death, recurrence, injury to the heart, lungs, and associated structures, bleeding, conversion to open informed consent was obtained. Please see chart for the consent.

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

    Prophylactic antibiotics were given by the Anesthesia Department.

    The ultrasound was used to map bilateral iliac femoral and distal arteries.

    The patient was prepped and draped in normal sterile fashion after appropriate anesthesia was given by the Anesthesia Department. Bilateral incisions were made along the previously mapped marks so as to expose the common, superficial and deep femoral arteries. Vessel loops were placed around these and we then placed a pursestring 5-0 around it in order to begin the cannulation to deploy the stent grafts. The case was then turned over to Dr. where then I assisted deploying the grafts. After this was done with fluoroscopy we then turned the case back over to myself where the sheaths were then removed directly after clamps were given. Heparin was given during the main body of the procedure. We then proceeded to repair the rents in the common femoral arteries with multiple 5-0 and figure-of-X in simple interrupted fashion. Irrigation and suction was utilized. Multiple layers of Vicryl and nylon was then used to close the skin and soft tissue. Protamine a half dose was given to reverse the heparin. Dopplerable pulses were heard bilaterally in the feet.

    Please help.....

    Thanks.

    Lisa

  2. #2
    Location
    Richardson, TX
    Posts
    823
    Default
    Oh I love these!

    34802-80
    34812-50

    Okay, the documentation is vague because it is missing the type of endovascular graft: AneuRx, Excluder, Endurant, Talent, Cook Zenith, AFX, Powelink or Endologix. Not all grafts fall under 34802, fyi.

    I also did not see the cath placement(s) in the Aorta but if they were there: 36200-50 (or 362000-LT; 36200- RT depending on what your doc performed)

    The documentation reads like your physician was the assistant? If so, then he/she won't be able to bill for the S&I of the graft placement (75952-26); that is also why I added mod-80 to 34802. If that is incorrect, please remove and bill 34802 with 75952-26. The 34812-50 relates to the bilateral com fem artery exposure.
    Last edited by jewlz0879; 09-11-2014 at 07:15 AM.
    Julie Graham, BA, CPC, CCC

  3. Default
    Our docs use IVUS which are add on codes. 37250 and 75945 along with the other codes.

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