Can anyone confirm my codes for the below procedure?
37184
37185
37224
I am also confused, whether we need to pick up 35371?
PREOPERATIVE DIAGNOSIS: Ischemic right lower extremity with thrombosed right
ax-fem bypass graft.
POSTOPERATIVE DIAGNOSIS: Ischemic right lower extremity with thrombosed right
ax-fem bypass graft.
PROCEDURES:
1. Redo right groin exploration.
2. Thrombectomy, right common femoral artery.
3. Thrombectomy, right ax-fem bypass graft.
4. Angiogram, right ax-fem bypass graft.
5. Percutaneous transluminal angioplasty of the right ax-fem bypass graft
using a 7 mm x 200 mm balloon, completion angiogram.
6. Angiogram right lower extremity.
PROCEDURE IN DETAIL: Informed consent was obtained. The patient was brought
to the operating room and placed in supine position. Adequate anesthesia was
obtained using general endotracheal intubation. The patient was prepped and
draped in normal sterile fashion. Time-out was performed confirming the
patient, operative procedure, and location. His previous right groin incision
was opened up. Subcutaneous tissue was divided with electrocautery.
Dissection was carried down to the right common femoral artery. The distal
aspect of the right limb of the ax-fem bypass graft was isolated and encircled
with vessel loops. There was a lot of scar tissue requiring careful
dissection down along the both ends of the common femoral artery. The common
femoral artery appeared to be somewhat aneurysmal proximally at 2 cm in
length. His right SFA was chronically occluded and only had a few branches
going down the deep femoral artery. The patient was given a bolus of heparin
10,000 units IV and what appeared to be a bovine patch on top of the common
femoral artery. A longitudinal arteriotomy was made with an 11-blade scalpel,
extended with Potts scissors. The graft was completely occluded. Although
there had been flow on admission, 3 days ago there was no flow present.
Thrombectomy was then performed. There was excellent bleeding from a very
large side branch, which was somewhat medial in nature. This side branch
appeared to be 3 to 4 mm in dimension. This was occluded after placing of #3
embolectomy catheter and inflating it with a 3-way stopcock for hemostasis.
The embolectomy was then performed to the right ax-fem bypass graft. The
chronic clot was removed as well as some fresh clots. I used both the #5
embolectomy catheter and #4 embolectomy catheter as well as a 4 to 6 and 5 to
7 adherent clot catheters. I was able to get fairly good inflow present but
there appeared to be some residual pseudointima present. The graftotomy was
then closed using running 5-0 Prolene. After this, I could feel there was a
fairly strong Doppler signal to the graft. At this time, the common femoral
artery was cannulated with entry needle and guidewire was passed up the ax-fem
bypass graft and a 5-French sheath was placed. Bentson guidewire was passed
up to the axillary artery and followed by a 5-French Glide catheter.
Angiogram was then performed. This showed that the bypass graft was patent
but there appeared to be a moderate amount of residual pseudointima lining the
graft. Because of that, I decided to do the balloon angioplasty of the whole
graft. The balloon angioplasty was then performed with a 7 mm x 200 mm
balloon up to 10 atmospheres for 3 minutes in an overlapping fashion. This
was done and the patient had excellent outflow present. Angiogram was then
performed which did show branches of the deep femoral artery going distally
but these all appeared to be very small. The sheath was then removed,
hemostasis was achieved with a 5-0 Prolene. Wounds were irrigated out. A #19
round Blake drain was brought out the inferior aspect incision and sewn in
place with heavy nylon.
37184
37185
37224
I am also confused, whether we need to pick up 35371?
PREOPERATIVE DIAGNOSIS: Ischemic right lower extremity with thrombosed right
ax-fem bypass graft.
POSTOPERATIVE DIAGNOSIS: Ischemic right lower extremity with thrombosed right
ax-fem bypass graft.
PROCEDURES:
1. Redo right groin exploration.
2. Thrombectomy, right common femoral artery.
3. Thrombectomy, right ax-fem bypass graft.
4. Angiogram, right ax-fem bypass graft.
5. Percutaneous transluminal angioplasty of the right ax-fem bypass graft
using a 7 mm x 200 mm balloon, completion angiogram.
6. Angiogram right lower extremity.
PROCEDURE IN DETAIL: Informed consent was obtained. The patient was brought
to the operating room and placed in supine position. Adequate anesthesia was
obtained using general endotracheal intubation. The patient was prepped and
draped in normal sterile fashion. Time-out was performed confirming the
patient, operative procedure, and location. His previous right groin incision
was opened up. Subcutaneous tissue was divided with electrocautery.
Dissection was carried down to the right common femoral artery. The distal
aspect of the right limb of the ax-fem bypass graft was isolated and encircled
with vessel loops. There was a lot of scar tissue requiring careful
dissection down along the both ends of the common femoral artery. The common
femoral artery appeared to be somewhat aneurysmal proximally at 2 cm in
length. His right SFA was chronically occluded and only had a few branches
going down the deep femoral artery. The patient was given a bolus of heparin
10,000 units IV and what appeared to be a bovine patch on top of the common
femoral artery. A longitudinal arteriotomy was made with an 11-blade scalpel,
extended with Potts scissors. The graft was completely occluded. Although
there had been flow on admission, 3 days ago there was no flow present.
Thrombectomy was then performed. There was excellent bleeding from a very
large side branch, which was somewhat medial in nature. This side branch
appeared to be 3 to 4 mm in dimension. This was occluded after placing of #3
embolectomy catheter and inflating it with a 3-way stopcock for hemostasis.
The embolectomy was then performed to the right ax-fem bypass graft. The
chronic clot was removed as well as some fresh clots. I used both the #5
embolectomy catheter and #4 embolectomy catheter as well as a 4 to 6 and 5 to
7 adherent clot catheters. I was able to get fairly good inflow present but
there appeared to be some residual pseudointima present. The graftotomy was
then closed using running 5-0 Prolene. After this, I could feel there was a
fairly strong Doppler signal to the graft. At this time, the common femoral
artery was cannulated with entry needle and guidewire was passed up the ax-fem
bypass graft and a 5-French sheath was placed. Bentson guidewire was passed
up to the axillary artery and followed by a 5-French Glide catheter.
Angiogram was then performed. This showed that the bypass graft was patent
but there appeared to be a moderate amount of residual pseudointima lining the
graft. Because of that, I decided to do the balloon angioplasty of the whole
graft. The balloon angioplasty was then performed with a 7 mm x 200 mm
balloon up to 10 atmospheres for 3 minutes in an overlapping fashion. This
was done and the patient had excellent outflow present. Angiogram was then
performed which did show branches of the deep femoral artery going distally
but these all appeared to be very small. The sheath was then removed,
hemostasis was achieved with a 5-0 Prolene. Wounds were irrigated out. A #19
round Blake drain was brought out the inferior aspect incision and sewn in
place with heavy nylon.