# Help please, I'm stumped



## ksnively (May 4, 2012)

Can someone help me with the op report below?  Should I code as 35286 or 35190 or perhaps something else?
Thank you,
Kim

Preop Diagnosis: Staphylococcus bacteremia, MRSA secondary to infected venous limb of left thigh arteriovenous loop graft

Postop Diagnosis: Same as above

Operative Procedure Performed: Excisional debridement and drainage of venous limb of the left thigh interposition loop AV graft

Findings:  There is an indurated tender area over the anteromedial aspect of the left thigh where the venous limb of the subcutaneous interposition grafts is located.  He udnerwent a Ceretec scan prior to the surgery which documented pickup of the radioactive material in the area of the venous limb of the interposition loop graft on the left thigh.

Operative Procedure: The pt was placed in a supine position and was given IV sedation.  The left thigh and elft groin areas were then painted with ChloraPrep, followed by application fo routine sterile drapes.  A local infiltration of local anesthesia was first injected at the distal aspect of th indurated area of abscess wherein a low vertical incision was then made over this area.  Dissection was carried through the sucutaneous fat layer where a well-incorporated graft was then identified and dissected, clamped, divided and suture ligated approximately at the venous limb of the arterial limb.  This was sutured with running continuous 4-0 Prolene suture material.  I then made another counter incision above the indurated area of thea bscess that is about the level of the proximal anteromedial aspect of the left thigh where again local infiltration of local anesthsia was injected at this level.  A transverse incision was made over this area and a blunt dissection was carried subcutaneously where again well-incorporated graft was identified at this level, applied, divided and ligated.  The proximal end of the divided graft was suture ligated with running continuous 4-0 Prolene suture material.  The isolated segment of the infected graft was then excised completely making elliptical excisional incision at the level of the indurated aspect of the abscess formation.  The whole infected graft was then excised completely.  The tunnel was copiously irrigated with pulse irrigator using a double antibiotic solution.  Idoform packing was then applied inside the tunnel and along the incision.  The incisions were kept open for open wound drainage.  Sterile dressing was then applied.  The patient tolerated the procedure well and elft the operating room in stable condition.


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## jewlz0879 (May 8, 2012)

I wouldn't use 35286 bc that is for a blood vessel and this is for an infected AV graft removal. I would go with 35190; if he/she were doing revision (fistula not removed) then I would go to 36832/36833. 

HTH


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## ksnively (May 10, 2012)

Thank you for your help, Julie!


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