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Help with coding Endovascular AAA Repair

  1. #1
    Default Help with coding Endovascular AAA Repair
    Medical Coding Books
    Need help on this, we don't do too many of these and I seen to struggle when we do. What I have is 34812-50, 34803, 34825, 75952-26. I'm I on the right track? Am I missing something? Here is the op report.

    Dx: AAA

    Operation performed: Endovascular stent graft repair abdominal aortic aneurysm.

    The patient was placed supine on the operating table, and the abdomen and groins were prepped and draped. The common femoral arteries were exposed through bilateral vertical incisions below the inguinal ligaments. These vessels were controlled with vessel loops and Rummels.

    The right groin was accessed with an 8-french sheath, and a Kumpe catheter was used to direct a flexible Bentson wire into the suprarenal aorta. The pigtail catheter was passed over this wire, and the wire was removed. The catheter was then used to obtain an arteriogram and identify and location of the renal arteries. A Lunderquest wire was inserted into the pigtail catheter and placed in the suprarenal aorta.

    The left common femoral was similarly accessed with an 8-French. Again, the Kumpe catheter was used to direct a Bentson wire into the suprarenal aorta. A wire exchange was preformed placing another Lunderquest on the left side. The main body of the graft was selected. This was a 26 x 14.5 mm bifurcated graft 14 cm long. The large sheath was inserted in the right groin. Through this, the stent graft was inserted and positioned directly below the origin of the renal arteries. Another arteriogram was obtained with the pigtail on the opposite side, and this confirmed the location of the renal arteries. The stent graft was deployed, positioning the top of the graft directly below the renal arteries.

    A sheath was inserted on the left side and positioned close to the left gate. The gate was accessed using the sheath and Kumpe catheter. When the gate had been accessed, the Kumpe was advanced and rotated within the graft to confirm that the gate and been accessed. The Bentson wire was replaced into the left gate.

    The right iliac was stented with a 12-mm x 14-cm stent, positioning the distal end just proximal to the right internal iliac. Finally, the left iliac was stented using a 14.5 x 10 cm graft.

    The iliacs were then ballooned to iron out the graft. Finally, an occlusion ballon wsa placed proximally in the aorta, and this was used to seal the neck. The wires and sheaths were taken out under direct vision and the arteriotomy sites were closed. Profusion was established.

  2. Default
    1. Did the endograft have one docking limb(34802), two docking limbs(34803) or a uni body-no docking limbs(34804)

    2. Were the iliac stents actually stents, endograft limbs or endograft extensions?

    IF a unibody graft w/ bilat iliac extensions then 34804,34812-50,34825,34826,36200-RT,36200-59LT,75952,75953,75953 would be approirate

    If endograft w/ two docking limbs then 34803,34812-50,36200-RT,36200-59LT, 75952

    Hope this helps

  3. #3
    Yes, it was a endograft with two docking limbs. Thanks so much, it really helped!

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