# Vascular Coding-need help coding



## herrera4 (Jul 6, 2010)

I am VERY new to vascular surgery and need help coding op report

PREOPERATIVE DIAGNOSIS:  Abdominal aortic and right common iliac artery aneurysm.

 POSTOPERATIVE DIAGNOSIS:  Abdominal aortic and right common iliac artery aneurysm.

TITLE OF OPERATION:  Endovascular repair of abdominal aortic and right common iliac artery aneurysm.


ANESTHESIA:  General with endotracheal tube. 

DESCRIPTION OF PROCEDURE:  The patient was placed in the supine position on the operating room table.  General endotracheal anesthesia was induced.  A Foley catheter was inserted, and the abdomen and both thighs were prepped and draped in standard fashion.  Bilateral oblique incisions were made at just distal to the groin crease.  Bleeding points controlled with electrocautery.  The deep fascia was incised and on the right side the common femoral, superficial and profunda femoris arteries were circumferentially dissected free and doubly looped with vessel loops.  On the left, the superficial femoral artery was doubly looped proximally and distally with vessel loops.  The right femoral artery was then needle punctured with a 19-gauge arterial entry needle.  Utilizing a Benson guidewire and J-wire, and an angled glide cath, the tortuous iliac bifurcation was navigated and the guidewire was eventually advanced into the suprarenal aorta.  A 25 cm, 8-French introducer sheath was advanced and placed at the level of the iliac bifurcation.  The marker pigtail catheter was placed over the guidewire and positioned at approximately the first lumbar vertebra.  On the left side, the femoral artery was needle punctured.  A Benson wire was advanced well up into the suprarenal aorta with the aid of an angled glide catheter.  The combination was advanced to the arch of the aorta and the guidewire was placed with a Lindqvist wire.  Initial digital subtracted, power injected aortogram demonstrated the level of the renal arteries and allowed final marking for the preparations and main body device.  A Cook TTFB 22-96 main body device was prepped, oriented properly under fluoroscopy.  Intravenous heparin 5000 units was given.  This was inserted through the left femoral artery and advanced into the proximal aorta.  A separate magnified aortogram identified the level of the left renal artery, which was the lowest.  The graft was manipulated and deployed with the proximal attachment site.  Three millimeters below the left renal artery, marked tortuosity in the aorta was well identified on the aortograms, and was resolved somewhat with placement of the stiff Lindqvist wire from the left.  The graft was deployed until the contralateral gate opened.  The suprarenal fixation hooks were also deployed.  The marker pigtail catheter had been withdrawn into the aneurysm below the proximal attachment site.
 Attention was then directed to the contralateral gate on the left.  Utilizing a Vanshee 2 catheter and a J guidewire, this was cannulated.  The wire was seen to advance above the suprapubic hooks.  Intraluminal position was confirmed by replacement of the Vanshee 2 catheter with the marker pigtail catheter, which was allowed to form and then axially rotated at the suprarenal fixation position, and also down into the main body device.  This was then advanced to the region of the aortic arch, and a second Lindqvist wire was placed in position, with its tip at the aortic arch.  The catheter was then withdrawn so that marker was visualized at the level of the contralateral gate.  With the image intensifier in the left anterior oblique position, retrograde angiography was performed through the indwelling 8-French sheath, demonstrating the level of distal attachment desired in the external iliac artery distal to the internal iliac coiling by 2 cm.  It was necessary to use two devices to achieve the length required., a TFLA 14 x 90 and TFLA 14 x 73 extension device.  These were placed with 1-1/2 stent overlap in the contralateral gate and extended to the external iliac artery as noted.  Deployment devices were retrieved per protocol.  Attention was then directed to the left side.  With the image intensifier in the right internal iliac position, the remainder of the main body device was deployed.  The nose cone of the suprarenal attachment hooks was captured and, under fluoroscopic vision, was gently retrieved through the main body device and removed.  The marker pigtail catheter was again inserted and positioned with a marker at the distal aspect of the main body device.  Retrograde iliac angiography was performed through the indwelling sheath and the distal common iliac artery was appreciated.  It was elected to place a TFLA 22-56 limb extension, with deployment at the distal ectatic common iliac artery.  This was prepped, inserted and deployed.  Following this, the deployment device was retrieved.  The Coda 30 balloon was then placed from the left side.  Gentle angioplasty of the proximal attachment site along the main body device of the left limb and distal attachment were performed.  The balloon was then shifted to the right side, where in similar fashion the distal attachment sites were treated with simple balloon angioplasty.  Finally,  completion angiography was performed through the left side by reinsertion of the marker pigtail catheter.  The Lindqvist wire on the left was exchanged for an exchange length Benson wire to allow the aorta to conform to normal position.  Completion aortography demonstrated no evidence of proximal or distal attachment site leaks.  There was no type 2 endo leaks noted.  The graft remained in good position.  The left renal artery was well visualized.
 All devices were retrieved.  The femoral arteriotomies were closed with running 5-0 Prolene sutures, following which pulsatile flow was confirmed distal to the arteriotomy sites, which had been vented prior to closure.  Hemostasis deemed adequate.  Topical Surgicel.  Irrigation with Ancef.  Closure in layers with 3-0 Vicryl and a running 4-0 Prolene subcuticular suture for skin.  Then 4 x 4 and Tegaderm dressings were placed, and the patient was awoke from anesthesia, extubated and transferred to the recovery room in good general condition.

*our surgeon usually codes his own reports- I do have some codes but would 35226 be billable??? Thank you for any help


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## lking (Jul 16, 2010)

*vascular coding*

no 35226 is not billable you should be billing 34812 50 modifier for bilateral for the groin incisions, the repair is included in that. I read it fast you can post the codes you feel are appropriate. 
just my 2 cents.
 Linda K


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