stpat
Networker
I've been given a vascular surgeon to code for since my manager seems to think I should be able to have all knowledge of this since I code cardiology! This is my first EVAR case and I am at a loss and want to make sure I am coding it right. My thought is 34803, 75952-26 and 34825 but I could be totally off base on this. Could anyone please give me some guidance? Thank you so much!
INDICATIONS: 68 y/o w male with 5.3 cm asymptomatic AAA. Adequate anatomy for EVAR. Have discussed risks and benefits of open and closed repairs. Plan on proceeding with EVAR.
Risks covered with, and accepted by, patient, and include, thrombosis, bleeding, infection, nerve injury, embolization, TIA, CVA, cardiopulmonary complications, contrast-induced nephropathy, limb ischemia, possible device migration leading to endoleak and aneurysm rupture, possible conversion to open repair.
*
PROCEDURE: *
The patient was brought to the operating room. Time out was performed by the team. After successful induction of general anesthesia, the patient was prepped and draped in the usual sterile fashion. Oblique incisions were performed in both groins, and the common femoral arteries were dissected and encircled with vessel loops. The patient was given 8,000units of heparin IV. Both femoral vessels were punctured with 9G needles and cannulated with 035 glide wires. A 5F sheath was placed over each wire. On the right groin, this sheath was exchanged for a 18F sheath, and on the left the entry sheath was exchanged for a 12F sheath. The main body of the device was then advanced over an Amplatz wire (which had been advanced into the thoracic aorta through a KMP catheter), after a scout angiogram had been performed with a pigtail catheter to mark the origins of the renal arteries. The main body of the device (35 mm x 14.5 mm x 14 cm) was advanced into position and then rotated such that the gate was in a favorable orientation for cannulation from the contralateral groin. The main body was deployed immediately below the renal arteries. *
Next, the gate was cannulated using a KMP and 035 glide catheter. Intra device positioning was confirmed by exchanging the KMP for a pigtail catheter and twirling it within the device. The contralateral limb (16 mm x 18 mm x 11.5 cm) was advanced over an Amplatz wire through the left 12F sheath and deployed with the correct amount of overlap with the main body of the device. A Coda balloon was then passed over the Amplatz wire and used to seat the proximal, mid, and distal fixation points on the left, than right. Next, because of the angulation, an endoleak was seen proximally. Therefore a 32 mm x 4.5 cm cuff was deployed below the renal arteries. In addition, a right limb extension was deployed measuring 16 mm x 14.5 mm x 10 cm was deployed. The coda balloon was used to seat the two extensions into place. A completion angiogram did not reveal any endoleaks, and appropriate exclusion of the aortic aneurysm, without compromising the renal or internal iliac vessels. *
The heparin was reversed with protamine. The femoral arteries were clamped and repaired with 7-0 prolene. The wounds were closed in 3 layers with 3-0 Vicryl suture. The skin was approximated with staples. The feet werewell perfused at the completion of the case. The wounds were dressed sterilely and the patient was taken to the recovery room in staple condition. All instrument and sponge counts were correct as told to me by the nursing staff.*
INDICATIONS: 68 y/o w male with 5.3 cm asymptomatic AAA. Adequate anatomy for EVAR. Have discussed risks and benefits of open and closed repairs. Plan on proceeding with EVAR.
Risks covered with, and accepted by, patient, and include, thrombosis, bleeding, infection, nerve injury, embolization, TIA, CVA, cardiopulmonary complications, contrast-induced nephropathy, limb ischemia, possible device migration leading to endoleak and aneurysm rupture, possible conversion to open repair.
*
PROCEDURE: *
The patient was brought to the operating room. Time out was performed by the team. After successful induction of general anesthesia, the patient was prepped and draped in the usual sterile fashion. Oblique incisions were performed in both groins, and the common femoral arteries were dissected and encircled with vessel loops. The patient was given 8,000units of heparin IV. Both femoral vessels were punctured with 9G needles and cannulated with 035 glide wires. A 5F sheath was placed over each wire. On the right groin, this sheath was exchanged for a 18F sheath, and on the left the entry sheath was exchanged for a 12F sheath. The main body of the device was then advanced over an Amplatz wire (which had been advanced into the thoracic aorta through a KMP catheter), after a scout angiogram had been performed with a pigtail catheter to mark the origins of the renal arteries. The main body of the device (35 mm x 14.5 mm x 14 cm) was advanced into position and then rotated such that the gate was in a favorable orientation for cannulation from the contralateral groin. The main body was deployed immediately below the renal arteries. *
Next, the gate was cannulated using a KMP and 035 glide catheter. Intra device positioning was confirmed by exchanging the KMP for a pigtail catheter and twirling it within the device. The contralateral limb (16 mm x 18 mm x 11.5 cm) was advanced over an Amplatz wire through the left 12F sheath and deployed with the correct amount of overlap with the main body of the device. A Coda balloon was then passed over the Amplatz wire and used to seat the proximal, mid, and distal fixation points on the left, than right. Next, because of the angulation, an endoleak was seen proximally. Therefore a 32 mm x 4.5 cm cuff was deployed below the renal arteries. In addition, a right limb extension was deployed measuring 16 mm x 14.5 mm x 10 cm was deployed. The coda balloon was used to seat the two extensions into place. A completion angiogram did not reveal any endoleaks, and appropriate exclusion of the aortic aneurysm, without compromising the renal or internal iliac vessels. *
The heparin was reversed with protamine. The femoral arteries were clamped and repaired with 7-0 prolene. The wounds were closed in 3 layers with 3-0 Vicryl suture. The skin was approximated with staples. The feet werewell perfused at the completion of the case. The wounds were dressed sterilely and the patient was taken to the recovery room in staple condition. All instrument and sponge counts were correct as told to me by the nursing staff.*