ksb0211
Guest
Just wondering if the shunt is included in the CPT 35301 or if there is another code that I should be including. Thanks so much.
PROCEDURE/OPERATION
Left carotid endarterectomy with shunt.
DESCRIPTION OF PROCEDURE
The patient is taken to the operating room. After the induction of adequate general anesthesia the patient is prepped with DuraPrep and draped sterilely. She was placed with her neck extended facing to the right. The skin was marked with for the planned incision and entered through the sternocleidomastoid muscle. The incision was made with a #15 blade. The venous structures were ligated as necessary to reach the common carotid artery. The carotid artery was encircled. Once we were sure of our location relative to the bifurcation, the dissection was continued in a cephalad direction. The bifurcation was identified. The external carotid artery was controlled first. The carotid bulb was injected with Lidocaine. The anterior carotid artery was then controlled. The hypoglossal nerve was well-identified and preserved. The patient was heparinized with 7000 units of intravenous heparin. Because of the history of cerebrovascular accident, a shunt was utilized. A 3 x 4 millimeter shunt was used. The shunt was placed without difficulty. Once this was done, the dissection was begun with a ____elevator. The plaque was relatively easily removed and feathered nicely distally. It was very grimes hemorrhage type plaque and clearly a good source for embolic process. Once we were sure that the media was clear of any loose debris, the packing sutures of 7-0 Prolene were utilized in the internal carotid artery. A patch of Dacron was then formed and secured in place with running 5-0 Hemosil suture. The arteriotomy was closed from both ends with the patch. Ultimately it was well-flushed. The shunt was removed and the patch fully closed. Good hemostasis was achieved. The 7 millimeter Jackson-Pratt drain was then placed by a separate stab incision. The musculature, platysma and sternocleidomastoid were reapproximated with interrupted 3-0 Vicryl suture. Clips were applied to the skin. Dry sterile dressing was applied. The estimated blood loss was perhaps 100 mL. The patient was taken to the recovery room in stable condition. She was moving her right upper extremity prior to leaving the operating room.
PROCEDURE/OPERATION
Left carotid endarterectomy with shunt.
DESCRIPTION OF PROCEDURE
The patient is taken to the operating room. After the induction of adequate general anesthesia the patient is prepped with DuraPrep and draped sterilely. She was placed with her neck extended facing to the right. The skin was marked with for the planned incision and entered through the sternocleidomastoid muscle. The incision was made with a #15 blade. The venous structures were ligated as necessary to reach the common carotid artery. The carotid artery was encircled. Once we were sure of our location relative to the bifurcation, the dissection was continued in a cephalad direction. The bifurcation was identified. The external carotid artery was controlled first. The carotid bulb was injected with Lidocaine. The anterior carotid artery was then controlled. The hypoglossal nerve was well-identified and preserved. The patient was heparinized with 7000 units of intravenous heparin. Because of the history of cerebrovascular accident, a shunt was utilized. A 3 x 4 millimeter shunt was used. The shunt was placed without difficulty. Once this was done, the dissection was begun with a ____elevator. The plaque was relatively easily removed and feathered nicely distally. It was very grimes hemorrhage type plaque and clearly a good source for embolic process. Once we were sure that the media was clear of any loose debris, the packing sutures of 7-0 Prolene were utilized in the internal carotid artery. A patch of Dacron was then formed and secured in place with running 5-0 Hemosil suture. The arteriotomy was closed from both ends with the patch. Ultimately it was well-flushed. The shunt was removed and the patch fully closed. Good hemostasis was achieved. The 7 millimeter Jackson-Pratt drain was then placed by a separate stab incision. The musculature, platysma and sternocleidomastoid were reapproximated with interrupted 3-0 Vicryl suture. Clips were applied to the skin. Dry sterile dressing was applied. The estimated blood loss was perhaps 100 mL. The patient was taken to the recovery room in stable condition. She was moving her right upper extremity prior to leaving the operating room.
