I'm having such a hard time coding this OP report. The codes I have are 75710-26, 37228-LT, 37226-LT. I'm struggling with the code for the stent removal, I'm not even sure there is a code for it. Based on the OP report, do you think I've captured everything? Any help would be greatly appreciated. Thanks in advance!
PREOPERATIVE DIAGNOSIS: ACUTE-ON-CHRONIC LIMB ISCHEMIA.
POSTOPERATIVE DIAGNOSIS: ACUTE-ON-CHRONIC LIMB ISCHEMIA.
OPERATION:
1. REMOVAL OF LYSIS CATHETER.
2. BALLOON ANGIOPLASTY OF ANTERIOR TIBIAL, TP, AND POPLITEAL ARTERY.
3. ______ PLACEMENT ANTERIOR TIBIAL AND TP-TRUNK.
4. LIFESTENT 5 X 100 WITHIN TP-TRUNK AND EXTENDING TO THE ABOVE-KNEE
POPLITEAL ARTERY.
5. INNOVA 6 X 80 STENT WITHIN THE PROXIMAL SUPERFICIAL FEMORAL ARTERY.
6. MID SFA CUTDOWN WITH REMOVAL OF INNOVA 5 X 40 STENT WITH PATCH
ANGIOPLASTY.
7. LEFT LOWER EXTREMITY FASCIOTOMY.
ANESTHESIA:
COMPLICATIONS: NONE.
BLOOD LOSS: 200 ML.
PROCEDURE:
The patient was brought back to the operating room and placed supine on
the operating room table. A timeout was performed, verifying the
correct patient, procedure, all available equipment. The left leg was
prepped and draped in the usual sterile fashion, as well as the left and
right groins. The left and right groins were prepped and draped in the
usual sterile fashion.
With the previously-placed ______ catheter, a diagnostic angiogram was
performed, showing excellent flow within the anterior tibial artery with
sluggish flow at the level of the TP. An 0.014 catheter was placed down
to the dorsalis pedal and the palmar arch and a 1.5 angioplasty balloon
was done along the entire length of this followed by an angioplasty
balloon and also looked like TPA to the palmar arch, 1 mg total.
Angiogram at this time showed significantly improved flow through the
anterior tibial, the dorsalis pedis and palmar arch. The previous
thrombus within the popliteal and SFA has all but resolved with some
mild residual disease in the TP-trunk. A 3 x 3 cm balloon was used to
perform balloon angioplasty of the TP-trunk into the popliteal, followed
by a 4 x 100 cm balloon. Intact stents were then placed into the
proximal TP-trunk with small areas of dissection. A LifeStent was then
used to stent from the TP-trunk to the above-knee popliteal using a 5 x
100 LifeStent. A 5 x 120 balloon was used. Post dilation, there were
excellent results and no evidence of residual thrombus and significantly
improved flow to foot through the anterior tibial, as well as DP and
palmar arch. There was still evidence of mild thrombus in the mid-SFA
and mild disease, so a 6 x 80 Innova was placed within the mid-SFA.
There was also residual disease at the adductor canal in the left lower
extremity. A 5 x 40 stent was placed. However, due to malfunctioning
of the stent, the stent did not deploy correctly. After attempting to
remove the sheath and the wire, the wire was stuck in the stent. A
decision was made to perform a cutdown overlying the SFA. A #15 blade
was used to make an incision in the thigh. Electrocautery was used to
open subcutaneous tissue as well as the fascia. The sartorius muscle
was mobilized and retracted superiorly. The superficial femoral artery
was identified and the sheath was opened. Circumferential control was
gained both proximal and distal. The area of the stent was palpated.
An #11 blade was used to create an arteriotomy. The stent was noted to
be curled around the guidewire and contributing to the missed
deployment. The stent was removed. The artery appeared to be intact
with no evidence of disease. Patch angioplasty was then done with the
0.8 x 8 bovine pericardial patch using 5-0 Prolene suture in a running
fashion both proximally and distally. There was excellent backbleeding
and was flushed with heparinized saline prior to completion. Prior to
closure, a completion angiogram was done that showed preserved runoff to
the foot through the DP and palmar arch and PT. No evidence of residual
disease. Of note, heparin was given throughout the case and ACTs were
checked. At this time, an 0.035 Glidewire Advantage was placed. The
sheath was removed and exchanged for a short 6-French sheath. A Mynx
device was used to gain hemostasis within the right groin. 4-0 Monocryl
was used to close the skin followed by a dry dressing. The mid-thigh
incision was closed in interrupted layers using 2-0 Vicryl and 3-0
Vicryl and 4-0 Monocryl. Dermabond was placed on the skin. Lower
extremity fasciotomies were then performed due to the prolonged ischemia
for over a week with concern for reperfusion injury. An incision was
made over the tibia in the left lateral aspect of the leg. This was
deepened through the skin using electrocautery. The lateral compartment
was opened and extended both proximally and distally using Metzenbaum
scissors. The intracompartmental septum was identified. The anterior
compartment was identified and it was also opened both proximally and
distally. Hemostasis was achieved. Xeroform dressing was placed on the
thigh. A medial incision was advanced in the medial aspect of the leg.
The posterior superficial compartment was opened with electrocautery and
was extended with Metzenbaum scissors both proximally and distally. The
______ were taken off the tibia and the deep posterior compartment was
then opened.
Hemostasis was achieved. Xeroform was placed in the wound. Both wounds
were wrapped with dry Kerlix dressing as well as an ACE bandage. The
patient at the completion of the case had a palpable DP pulse. The
patient was extubated and brought to the PACU in stable condition.
PREOPERATIVE DIAGNOSIS: ACUTE-ON-CHRONIC LIMB ISCHEMIA.
POSTOPERATIVE DIAGNOSIS: ACUTE-ON-CHRONIC LIMB ISCHEMIA.
OPERATION:
1. REMOVAL OF LYSIS CATHETER.
2. BALLOON ANGIOPLASTY OF ANTERIOR TIBIAL, TP, AND POPLITEAL ARTERY.
3. ______ PLACEMENT ANTERIOR TIBIAL AND TP-TRUNK.
4. LIFESTENT 5 X 100 WITHIN TP-TRUNK AND EXTENDING TO THE ABOVE-KNEE
POPLITEAL ARTERY.
5. INNOVA 6 X 80 STENT WITHIN THE PROXIMAL SUPERFICIAL FEMORAL ARTERY.
6. MID SFA CUTDOWN WITH REMOVAL OF INNOVA 5 X 40 STENT WITH PATCH
ANGIOPLASTY.
7. LEFT LOWER EXTREMITY FASCIOTOMY.
ANESTHESIA:
COMPLICATIONS: NONE.
BLOOD LOSS: 200 ML.
PROCEDURE:
The patient was brought back to the operating room and placed supine on
the operating room table. A timeout was performed, verifying the
correct patient, procedure, all available equipment. The left leg was
prepped and draped in the usual sterile fashion, as well as the left and
right groins. The left and right groins were prepped and draped in the
usual sterile fashion.
With the previously-placed ______ catheter, a diagnostic angiogram was
performed, showing excellent flow within the anterior tibial artery with
sluggish flow at the level of the TP. An 0.014 catheter was placed down
to the dorsalis pedal and the palmar arch and a 1.5 angioplasty balloon
was done along the entire length of this followed by an angioplasty
balloon and also looked like TPA to the palmar arch, 1 mg total.
Angiogram at this time showed significantly improved flow through the
anterior tibial, the dorsalis pedis and palmar arch. The previous
thrombus within the popliteal and SFA has all but resolved with some
mild residual disease in the TP-trunk. A 3 x 3 cm balloon was used to
perform balloon angioplasty of the TP-trunk into the popliteal, followed
by a 4 x 100 cm balloon. Intact stents were then placed into the
proximal TP-trunk with small areas of dissection. A LifeStent was then
used to stent from the TP-trunk to the above-knee popliteal using a 5 x
100 LifeStent. A 5 x 120 balloon was used. Post dilation, there were
excellent results and no evidence of residual thrombus and significantly
improved flow to foot through the anterior tibial, as well as DP and
palmar arch. There was still evidence of mild thrombus in the mid-SFA
and mild disease, so a 6 x 80 Innova was placed within the mid-SFA.
There was also residual disease at the adductor canal in the left lower
extremity. A 5 x 40 stent was placed. However, due to malfunctioning
of the stent, the stent did not deploy correctly. After attempting to
remove the sheath and the wire, the wire was stuck in the stent. A
decision was made to perform a cutdown overlying the SFA. A #15 blade
was used to make an incision in the thigh. Electrocautery was used to
open subcutaneous tissue as well as the fascia. The sartorius muscle
was mobilized and retracted superiorly. The superficial femoral artery
was identified and the sheath was opened. Circumferential control was
gained both proximal and distal. The area of the stent was palpated.
An #11 blade was used to create an arteriotomy. The stent was noted to
be curled around the guidewire and contributing to the missed
deployment. The stent was removed. The artery appeared to be intact
with no evidence of disease. Patch angioplasty was then done with the
0.8 x 8 bovine pericardial patch using 5-0 Prolene suture in a running
fashion both proximally and distally. There was excellent backbleeding
and was flushed with heparinized saline prior to completion. Prior to
closure, a completion angiogram was done that showed preserved runoff to
the foot through the DP and palmar arch and PT. No evidence of residual
disease. Of note, heparin was given throughout the case and ACTs were
checked. At this time, an 0.035 Glidewire Advantage was placed. The
sheath was removed and exchanged for a short 6-French sheath. A Mynx
device was used to gain hemostasis within the right groin. 4-0 Monocryl
was used to close the skin followed by a dry dressing. The mid-thigh
incision was closed in interrupted layers using 2-0 Vicryl and 3-0
Vicryl and 4-0 Monocryl. Dermabond was placed on the skin. Lower
extremity fasciotomies were then performed due to the prolonged ischemia
for over a week with concern for reperfusion injury. An incision was
made over the tibia in the left lateral aspect of the leg. This was
deepened through the skin using electrocautery. The lateral compartment
was opened and extended both proximally and distally using Metzenbaum
scissors. The intracompartmental septum was identified. The anterior
compartment was identified and it was also opened both proximally and
distally. Hemostasis was achieved. Xeroform dressing was placed on the
thigh. A medial incision was advanced in the medial aspect of the leg.
The posterior superficial compartment was opened with electrocautery and
was extended with Metzenbaum scissors both proximally and distally. The
______ were taken off the tibia and the deep posterior compartment was
then opened.
Hemostasis was achieved. Xeroform was placed in the wound. Both wounds
were wrapped with dry Kerlix dressing as well as an ACE bandage. The
patient at the completion of the case had a palpable DP pulse. The
patient was extubated and brought to the PACU in stable condition.
