# Endovascular Repair of Iliac Artery Aneurysm



## nlbarnes (Mar 24, 2017)

34900-50
34825
34826
75625
76937 x 2

77002? per coding companion?
Also, coding companion states "intro of guide wires (36200, 36215-36218) are also reported separately.  I need help with that as well.

OPERATIVE PROCEDURE
Bilateral common femoral 
arterial access was obtained under ultrasound guidance.  Using 
micropuncture catheter kits bilateral fluoroscopy of those groins 
confirmed common femoral access.  6-French sheaths were advanced over 
a J wires into the common femoral access bilaterally.  Bilateral 
common femoral arteriotomies were pre-closed with ProGlide Perclose 
devices x2 in both groins.  8-French sheaths were placed into both 
groins.  The patient was heparinized to a goal ACT of 250 and this was 
checked every half an hour for re-dosing to maintain an ACT greater 
than 250 through the duration of the case.  The left iliac branch 
device was deployed first over a stiff Amplatz wire through a 16- 
French DrySeal sheath.  The left iliac branch device was then 
cannulated with a 12-French sheath from the right groin, snared and 
brought up over into the hypogastric artery case.  A 7 x 14.5 mm limb 
was then deployed into the left hypogastric to cover the left 
hypogastric artery aneurysm.  This was then extended with an 
additional 7 x 14.5 extension.  Confirmation fluoroscopy demonstrated 
excellent seal of the hypogastric with preservation of outflow 
branches.  The external iliac limb was deployed without complication. 
Having successfully deployed the left iliac branch device the right 12- 
French sheath was then up-sized to a 16-French sheath and the right 
iliac branch device was deployed through the 16-French sheath.  A 12- 
French sheath was snared from the left hand side and brought up into 
the right iliac branch device once deployed.  The right hypogastric 
artery was cannulated and a 7 x 16 limb extension was deployed into 
the right hypogastric artery, followed by secondary extension also 
measuring 7 x 16.  Confirmation fluoroscopy demonstrated excellent 
deployment with preservation of the outflow branches and exclusion of 
the right hypogastric artery aneurysm.  Both of the limb extensions on 
the right and left hand side into the hypogastric artery required 
deployment over stiff wires and both were moderately technically 
challenging.  However, at deployment of the right iliac extension of 
the right iliac device, we had successfully excluded both common iliac 
and internal hypogastric artery aneurysms bilaterally.  At this time, 
we turned our attention to the infrarenal abdominal aortic aneurysm. 
An aortogram at the level of the renals was obtained. A Gore Excluder 
measuring 26 at the aortic neck was deployed and then readjusted 
accounting for parallax to a level approximately 4 mm below the renal 
arteries.  Once deployed, 2 bell-bottom limbs were deployed from the 
main body graft into the bilateral iliac branch devices with left bell- 
bottom measuring 10 x 27 and right bell-bottom measuring 12 x 27 mm. 
These were deployed without complication.  Confirmation fluoroscopy at 
completion of deployment of the bell-bottom limbs into the iliac 
branch devices demonstrated a type 1A endoleak and approximately 5 mm 
of space between the top of the main body graft and the renal 
arteries.  An aortic cuff was deployed measuring 26 mm x 3.3 cm to 
extend the main body seal to the level of the renal arteries.  This 
was post deployed, inflated with a Q50 balloon and this demonstrated 
excellent seal on completion angiogram with no evidence of type 1A, 
Type 1B, type 2 or type 3 endoleak on completion angiogram.  At this 
time, satisfied with exclusion of all of the patient's aneurysms the 
wires and sheaths were withdrawn and the arteriotomies were closed 

701889320_03_15


----------



## amexnikki23 (Apr 25, 2017)

Hi! I was wondering if you figured any of this out. Brand new to me. The provider is using terms like "coil" and "sheath" and I don't see "stent" or "cuff" or "extender" anywhere which seem to be the most common words used in these types of OP notes (or at least the ones I'm seeing on here), so I feel like I'm reading a foreign language. The documentation seems extremely lacking to me. 

"both groins were accessed w/US guidance & a 6-french sheath placed. We then proceeded w/placement of sheaths on the left side. The right side we performed embolization and coiling of the left internal hypogastric artery & then proceeded w/abdo aortic aneurysm."

Can you point out these codes in this OP note? The only thing I see clearly is the 34812-50 to be honest. And possibly the 34802, but I'm not getting the 34825/26 AT ALL. Any help is greatly appreciated!      34802  34812-50   34825   34826?



nlbarnes said:


> 34900-50
> 34825
> 34826
> 75625
> ...


----------

