# NEW vascular coder needs help



## ndriley10 (Sep 23, 2011)

I'm new to vascular coding and struggling tremendously with procedures and how to code them.  I am trying to code the following:

PROCEDURES PERFORMED:
1.  Bilateral common femoral artery exposure.
2.  Endovascular aneurysm repair with a bifurcated Zenith device (36 x 95 main body, right limb 14 x 56, left limb 16 x 90).
3.  Angiogram left lower extremity run off.
4.  Catheter in aorta from left common femoral artery.
5.  Stent left external iliac artery.
6.  Left common femoral endarterectomy with patch angioplasty using bovine pericardial patch.

I've got 34812-50, 34803, 75952, 36200, 36216, 35371

the op note is as follows:
Vertical incisions were made in the common femoral arteries bilaterally in case a femoral femoral bypass was necessary.  The common femoral artery was controlled proximally at the level of the inguinal ligament and distally.  The profunda and superficial femoral arteries were controlled, all of which were controlled with Potts vessel loops.  The right common femoral artery was punctured with an 18 gauge needle and a Bentson wire was advanced into the abdominal aorta under fluoroscopic guidance.  There was a palpable pulse in the left distal external iliac artery which was punctured with an 18 gauge needle.  A Bentson wire was advanced into the abdominal aorta under fluoroscopic guidance.

The patient was then administered 80 units per kilogram of heparin.  ACTs were drawn at 3 and 45 minutes and the heparin was bolused in order to manage an ACT level greater than 250.

The main body device was brought up onto the back table and thoroughly flushed.  This 35 x 95 main body was then advanced through the right common femoral artery under fluoroscopic guidance and brought up to the level of the renal arteries.  Omniflush catheter was advanced through the left external iliac artery access site and the injection was performed and the renal arteries were identified and marked on the screen. The endovascular device was then deployed under fluoroscopic guidance with the material of the main body being placed 1 mm distal to the lowest most renal artery on the left.  The top stent was then deployed under fluoroscopic guidance and the contralateral gate was then cannulated with a Bentson wire and Kumpe catheter.  Lunderquist wires were then placed through the contralateral gate and the left external iliac artery was dilated with serial dilators starting with a 12 followed by a 16 followed by an 18 followed by a 20 Cook dilator.  Subsequently, the contralateral limb was placed on the left and was noted to be a 16 x 90 and was deployed under fluoroscopic guidance with the lowest most portion of the limb located just above the hypogastric artery on the left. Attention was then paid towards the right. The ipsilateral gate was released followed by recapturing the top cap of the delivery device under fluoroscopic guidance.  An 18 French sheath was placed in through the right and the ipsilateral limb was then advanced into the main body.  A 14 x 56 device was deployed on the right to seal the right iliac artery with the distal most aspect of the graft approximately 1 mm above the hypogastric artery on the right. An angiogram was then performed identifying no endovascular leak into the abdominal aortic aneurysm with patent hypogastric arteries bilaterally, patent renal arteries bilaterally.  Attention was then paid towards the left external iliac artery.  Measurements were made and an 8 x 80 Zover stent was then placed into the left external iliac artery and was subsequently balloon angioplastied with a 7 mm balloon.  Attention was then paid towards the left common femoral artery.  The left common femoral artery was opened with an arteriotomy. The endarterectomy was performed with a Penfield and a patch angioplasty was sewn into place using a 5-0 Prolene suture in running fashion.  All vessels were thoroughly flushed before tying down the knot.  Upon completion the patient had a palpable pulse in his superficial and profunda arteries.  Attention was then paid towards the right common femoral which was closed in a running fashion. Thorough flushing of the vessels was performed before complete closure. The subcutaneous tissues were then thoroughly irrigated and closed in three layers, all three layers using a 3-0  Vicryl suture in interrupted fashion followed by a 4-0 Vicryl for the skin and Dermabond for the skin.  

Any help would be greatly appreciated


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## donnajrichmond (Sep 24, 2011)

Where did you get 36216? 
I don't see that you coded for the stent placed in the left external iliac  (it reads like a separate stent and not an extension cuff, but you might want to check)


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## rhondatalley (Sep 28, 2011)

I think you will need to add 37221 for the stent placement in the iliac.

Rhonda Talley, CPC


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