# ascending aortic and descending aneurysm repair



## hencked (Jan 12, 2012)

I struggle with these aneurysm repairs and the doctor and I are in disagreement on this one.  I am looking at 33870 and 33875.  Doctor is saying 33860, 33870 and 33880.  Sorry, it's long, I'll try to list most pertienent info.

Op perrformed: Replacement of ascending aorta and aortic arch with translocation of the head vessels to the ascending aorta and placement of TAG endograft for descending thoracic aneurysm with dissection.

Sternotomy performed, cardiopulmonary bypass was instituted. Ascending aorta was resected from just below the aortic crossclamp to the area just above the sinotubular junctions.Aortic leaflets appeared somewhat thickened but pliable.  Coaptation was judged excellent, no clcification noted.  A 34mm Hemashield graft chosen.  Patient cooled, crossclamp removed.  The remainder of the ascending aorta and the head vessel insertion including left subclavian were taken off the aorta as a Carrel patch.  A 26mm Hemashield platinum graft was then sutured over the origin of the head vessels for translocation of the head vessels to the ascending aorta.  Occlusion clamp on the innominate artery was removed, and the anastomosis was completed.  Head vessel graft was then de-aired and clamped.  Blood flow reinstituted to the head and arms.  Attention turned to the descending aorta.  A 34 mm Hemashield platinnum graft was then sutured in and end to end fashion to the descending aorta with suture.  After completion of this anastomosis, a 37mm TAG Gore-Tex endograft was then placed across the anastomosis into the ascending thoracic aorta.  Tag endograft measured 15 cm in length.  This step of the operation was chosen given the 5 cm in diameter in nature descending thoracic aorta and patient's ongoing back pain.  This will aslo help to buttress a  somewhat difficult anastomosis.  The TAG endograft was secured to the 34mm graft with suture.  The inner graft was ballooned and excellent coaptation was noted.  A standard cannula wa placed and flow was then instituted to the lower body.  A portion of the 34mm graft was then sutured to the ascending aorta component just above the sinotubular junction.  Teflon felt buttress was utilized.  A graft to graft anastomosis between the graft to the ascending aorta and that to the descending aorta was then performed.  The 26mm graft was then sutured in and end to side fashion to the 34mm neo-ascending aorta.  With completion of all these grafts, all cross calmps were removed.  Procedure was ended.

I don't understand 33880 as I don't think this is an endovascular repair.  I have coded some of those with my general surgeon and a IR as a co-surgery, but this doesn't sound the same.  Any help would be appreciated.  

Deb H.


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## jewlz0879 (Jan 20, 2012)

hencked said:


> I struggle with these aneurysm repairs and the doctor and I are in disagreement on this one.  I am looking at 33870 and 33875.  Doctor is saying 33860, 33870 and 33880.  Sorry, it's long, I'll try to list most pertienent info.
> 
> Op perrformed: Replacement of ascending aorta and aortic arch with translocation of the head vessels to the ascending aorta and placement of TAG endograft for descending thoracic aneurysm with dissection.
> 
> ...




I get 33870 and 33875. I agree with you on the 33875 because his dication does not seem to reflect a Endovascular deployment of the descending thoracic aorta graft. Can you physician point out why he thinks it should be 33880 within the report so that way you can understand his verbiage? You can also tell him the 33860/33870 are bundled.


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