# Resection of median arcuate ligament



## GIBBERS (Nov 5, 2010)

I need to precert this surgery which is coming up next week. I can not find any cpt code for 'resection of median arcuate ligament' which is done for celiac axis compression syndrome.  I am hoping not to have to use an 'unlisted' laparotomy code.
Thanks for your help!


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## preserene (Nov 5, 2010)

median arcuate ligament of diaphragm. The medial arcuate ligament (also medial lumbocostal arch) is tendinous fascia that arches over the psoas major muscle as it passes through the diaphragm. 
Structure
The medial arcuate ligament is an arch in the fascia covering the upper part of the psoas major. It is attached to the side of the body of the first or second lumbar vertebra; laterally, it is fixed to the front of the transverse process of the first and, sometimes also, to that of the second lumbar vertebra.


  Look into this code39560 Ressection diaphragm withsimple repair(eg primary suture) could help or not.


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## preserene (Nov 5, 2010)

Please have look to have  a little more clarity:

Compression of the celiac axis by this ligament is referred to as celiac artery compression syndrome or median arcuate ligament syndrome, and it has been reported to cause intestinal angina

The median arcuate ligament of the diaphragm is formed by muscular fibers that connect the right and left crura of the diaphragm, and it defines the anterior margin of the aortic hiatus. Compression of the celiac axis by this ligament is referred to as celiac artery compression syndrome or median arcuate ligament syndrome, and it has been reported to cause intestinal angina, although this diagnosis has been disputed in the surgery literature . Additionally, this entity has been reported to predispose patients who have undergone orthotopic liver transplantation to develop hepatic artery thrombosis . While surgical treatment can lead to persistent clinical improvement in symptomatic patients , the importance of celiac artery compression in asymptomatic patients is unknown. 
The character and position of the median arcuate ligament are highly variable. In an autopsy series it was observed that the celiac artery origin was at or above the median arcuate ligament in 33% (25 of 75) of cases. Results of conventional angiographic studies dating to the early 1970s showed that the positions of the median arcuate ligament, celiac artery, and aorta vary considerably during respiration and that median arcuate ligament compression is often accentuated during expiration


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## GIBBERS (Nov 8, 2010)

Thanks so much for your help!


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## EMMANUELA (Sep 19, 2014)

*robotic laparoscopic lysis of celiac artery*

need to know the cpt for robotic laparoscopic lysis of celiac artery


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## Janet Kidneigh (Apr 14, 2016)

*median arcuate ligament release*

My surgeon suggested that we use 35761 for the ligament release, since this is done to decompress the celiac artery.  35761 is the arterial exploration and lysis code.

Janet Kidneigh  CPC CPC-H


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