Can someone please help me with the CPT coding of an open repair of juxtarenal ruptured abdominal aortic aneurysm?
Below is the op note:
The abdomen was prepped and drpaed in rapid fasion, loban was placed.
There was no free blood within the abdominal compartment. The retroperitoneum was densely stained along the left portion of the aorta and down the iliacs towards the kidney and up towards the pancreas, displacing the ligament of Treitz. this area was bluntly dissected. The renal vein was identified and moved superiorly and control of the proximal aorta was obtained with direct clamping.
Upon completion of this, the distal aorta at the bifurcation was clamped after blunt dissection and both was relatively easily done. There was not free rupture of the aneurysm during the clamping. After this suprarenal control based upon the angulation underneath the renal vein was above the renal artery. The patient received Mannitol and underwent systemic heparinization and injuring the aneurysm sac revealed a large amount of thrombus and the proximal neck was identified. Loose aortic cheese was removed grossly. When this was completed a 18 Dacron graft was then sewed in place with 3-0 Prolene and an end-to-end anastomosis. Pledgetted-stitches were utilized and clamp time was less than 20 minutes suprarenal. After this was completed, the clamp was moved down the aorta. The anastomosis was tested and deemed hemostatic. A single lumbar artery was closed from inside the lumen before anastomotic closure was performed. upon completion of this, flow was returned to the lower extremities. The abdomen was copiously irrigated. A permanent suture was utilized to close the aneurysm sac and ultimately a Vicryl. The duodenum was noted to be preserved and separated from the aneurysmal sac and from the new graft.
Thank you.
Below is the op note:
The abdomen was prepped and drpaed in rapid fasion, loban was placed.
There was no free blood within the abdominal compartment. The retroperitoneum was densely stained along the left portion of the aorta and down the iliacs towards the kidney and up towards the pancreas, displacing the ligament of Treitz. this area was bluntly dissected. The renal vein was identified and moved superiorly and control of the proximal aorta was obtained with direct clamping.
Upon completion of this, the distal aorta at the bifurcation was clamped after blunt dissection and both was relatively easily done. There was not free rupture of the aneurysm during the clamping. After this suprarenal control based upon the angulation underneath the renal vein was above the renal artery. The patient received Mannitol and underwent systemic heparinization and injuring the aneurysm sac revealed a large amount of thrombus and the proximal neck was identified. Loose aortic cheese was removed grossly. When this was completed a 18 Dacron graft was then sewed in place with 3-0 Prolene and an end-to-end anastomosis. Pledgetted-stitches were utilized and clamp time was less than 20 minutes suprarenal. After this was completed, the clamp was moved down the aorta. The anastomosis was tested and deemed hemostatic. A single lumbar artery was closed from inside the lumen before anastomotic closure was performed. upon completion of this, flow was returned to the lower extremities. The abdomen was copiously irrigated. A permanent suture was utilized to close the aneurysm sac and ultimately a Vicryl. The duodenum was noted to be preserved and separated from the aneurysmal sac and from the new graft.
Thank you.