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AAA stent graft and Iliac embloization

  1. #1
    Default AAA stent graft and Iliac embloization
    Medical Coding Books
    Need help with coding this... am not familiar with AAA procedure. Would appreciate any help with this. Thank u in advance!!


    PREOPERATIVE DIAGNOSIS:
    Distal aortic suture line pseudoaneurysm and two right iliac
    aneurysms.

    POSTOPERATIVE DIAGNOSIS:
    Distal aortic suture line pseudoaneurysm and two right iliac
    aneurysms.

    OPERATIVE PROCEDURE:
    1. Abdominal aortic stent graft.
    2. Embolization of right internal iliac artery.


    PROCEDURE: The patient was brought in the operating room and
    placed in the supine position and underwent induction of general
    endotracheal anesthesia. He was then positioned, prepped, and
    draped in the usual sterile fashion.

    Initial step was to place an 8-French sheath in the left groin,
    which was done percutaneously. Once this was in place transverse
    incision was made over the right groin and the common femoral
    artery exposed for adequate length.
    Initial step here was to embolize the right internal iliac
    artery. Initially we tried this by placing a 6-French sheath in
    the right femoral artery and accessing the internal iliac with
    various sorts of hook-type guiding catheters. We were
    unsuccessful in this after an extended period of time. Next we
    went to the left groin, crossed the iliac bifurcation using a
    contra catheter and glidewires. We were able to get a guidewire
    into the internal iliac and extend the guiding cath in but were
    never able to extend the sheath into that area. After an
    extended period of time doing this, Dr. X graciously came in
    and helped us address this problem. He was able to get a guiding
    catheter over to the 8-French x 55 sheath at the left groin over
    the bifurcation and once this was in place then cannulate the
    internal iliac with an 0.014 coronary wire over which we were
    able to eventually advance the sheath and get good purchase into
    the internal iliac artery.

    Once we had done this two Amplatz occluder devices, first an 8 mm
    and then once this was deployed per routine a second 6-mm Amplatz
    occluder device was deployed. Once this was done initial
    angiogram showed continued flow into the internal iliac artery
    but good position of the Amplatz devices.

    Once we had gotten this done, which actually took a number of
    hours, we proceeded on with the aneurysm repair. The short 8-
    French sheath was replaced in the left groin. A 12-French strip-
    away sheath was placed in the right groin. Once these were in
    place a Meier wire was advanced up the right iliac into the
    thoracic aorta. The Endologix device was then advanced up over
    the wire into the thoracic aorta loaded with a 28 x 16 __________
    bifurcator device. Just prior to placing this, the SurePass
    guidewire to the contra lateral limb was advanced up the sheath
    grabbed with a snare and brought out the left 8-French sheath.
    Once we had done this we were able to strip away the strip-away
    sheath in the right groin advancing the entire device up into the
    thoracic aorta as noted above. Once this was in position the
    wires were in the sheath and the device was appropriately
    oriented and wires under nice control, we were able to retract
    the stent graft integrating sheath below the iliac bifurcation.
    Once we had done this we were able to pull the entire system down

    to the aortic bifurcation seating it nicely by the aortic
    bifurcation. An 0.014 Endologix wire was then advanced up the
    SurePass contra limb precannulating gate before deployed. Once
    we had done this we deployed the main body of the graft by
    pulling the device control cord. Having done this we were able
    to retract the integrated sheath deploy the ipsilateral limb.

    Having successfully deployed both limbs a pigtail catheter was
    advanced up the 0.014 left groin 0.014 wire and aortogram
    performed. Note the location of the renal arteries were noted at
    this point in time. Having done this we placed the infrarenal 34-
    34-100 aortic extension using the pin and pull technique and
    placed it just at the top of the previously placed graft
    specifically below the area of about 50% narrowing in the main
    aorta. Once this was successfully deployed the main body overlap
    and proximal areas were dilated with a Reliant balloon and the
    right limb of the graft dilated as well.

    At this point in time we advanced an 0.014 guidewire back up the
    pigtail catheter, pulled it back to the aortic bifurcation then
    carefully advancing it up using a little twirl as went. We

    advanced the pigtail back up to the aorta just above the upper
    limits of the graft. Having done this we were able to go ahead
    over the right limb guidewire advance a 20 x 13 x 70 right limb
    extension. We positioned this and successfully deployed this.
    Having done this, Coda balloon was used to dilate this as well.

    Following this a completion arteriogram was shot. We showed no
    evidence of any endoleak. The proximal location was perfect. By
    this time the right internal iliac was totally occluded as per
    our plans with good flow into the right iliac artery. We felt at
    this point we did not need to dilate the left limb as there was
    good apposition and good flow.

    Having done all this we were able to go ahead and remove all the
    devices from the right femoral artery. Clamps were applied and
    the artery carefully reapproximated using 6-0 Prolene. This was
    a heavily diseased artery and actually we noted we did have
    virtually no back flow. However once we got the artery repaired,
    released the clamp to good pulse and good Doppler pulse from the
    left ankle and so we felt we were okay.

    Having done this ACT was done and was found to be adequate. The
    right groin was closed using running 3-0 Vicryl deep and running
    subcuticular 4-0 Vicryl on the skin. The left 8-French sheath
    was removed and we used a Mynx closure device for this procedure.
    This worked well and successfully.

  2. #2
    Location
    Richardson, TX
    Posts
    823
    Default
    Take a look at 34802-34808

    If he does femoral cutdowns 34812 - 50

    Placement of cath in aorta 36200 - 50 (if done bilaterally)

    Cuffs or extentions (NOT contralateral limb) 34825/34826
    Julie Graham, BA, CPC, CCC

  3. #3
    Default
    Quote Originally Posted by jewlz0879 View Post
    Take a look at 34802-34808

    If he does femoral cutdowns 34812 - 50

    Placement of cath in aorta 36200 - 50 (if done bilaterally)

    Cuffs or extentions (NOT contralateral limb) 34825/34826

    How will i know if he does femoral cutdowns? is that how he would say it?? this whole note still has me confused.. i've not dones these before.. ugghhh...

  4. Default
    Initial step was to place an 8-French sheath in the left groin,
    which was done percutaneously. Once this was in place transverse
    incision was made over the right groin and the common femoral
    artery exposed for adequate length-34812 ( no -50 modifier)

    The Endologix device was then advanced up over
    the wire into the thoracic aorta loaded with a 28 x 16 __________
    bifurcator device. 34804 (unibody graft)(MAIN CODE)

    we placed the infrarenal 34-
    34-100 aortic extension --34825 (aortic extension)

    Having done this we were able to go ahead
    over the right limb guidewire advance a 20 x 13 x 70 right limb
    extension.--34826(additional extension)(ADD ON)

    Once we had done this two Amplatz occluder devices, first an 8 mm
    and then once this was deployed per routine a second 6-mm Amplatz
    occluder device was deployed. Once this was done initial
    angiogram showed continued flow into the internal iliac artery
    but good position of the Amplatz devices.--34808(iliac occusion)(ADD ON)

    additional codes needed

    36245-LT for lt side cath placement
    36200-59, RT for rt side cath placement
    75952-26 for S&I for EVAR
    75953-26 X2 for S&I for extensions


    Have a great day

  5. #5
    Default
    Quote Originally Posted by lisammy View Post
    Initial step was to place an 8-French sheath in the left groin,
    which was done percutaneously. Once this was in place transverse
    incision was made over the right groin and the common femoral
    artery exposed for adequate length-34812 ( no -50 modifier)

    The Endologix device was then advanced up over
    the wire into the thoracic aorta loaded with a 28 x 16 __________
    bifurcator device. 34804 (unibody graft)(MAIN CODE)

    we placed the infrarenal 34-
    34-100 aortic extension --34825 (aortic extension)

    Having done this we were able to go ahead
    over the right limb guidewire advance a 20 x 13 x 70 right limb
    extension.--34826(additional extension)(ADD ON)

    Once we had done this two Amplatz occluder devices, first an 8 mm
    and then once this was deployed per routine a second 6-mm Amplatz
    occluder device was deployed. Once this was done initial
    angiogram showed continued flow into the internal iliac artery
    but good position of the Amplatz devices.--34808(iliac occusion)(ADD ON)

    additional codes needed

    36245-LT for lt side cath placement
    36200-59, RT for rt side cath placement
    75952-26 for S&I for EVAR
    75953-26 X2 for S&I for extensions


    Have a great day
    THANK YOU SO MUCH!!!! I have been ready to pull my hair out over this one!

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