iamlou
Networker
Please help with this. I am very new to interventional coding and haven't come across one of these yet.
PROCEDURE: Left iliofemoral endarterectomy with patch angioplasty.
ANESTHESIA: General anesthesia
PROCEDURE IN DETAIL: Antibiotics were given. Time out was called. The
patient was identified. General anesthesia was done. We prepped and
draped in the lower abdomen and legs. I made a vertical groin incision
over the left inguinal ligament, dissected down to the inguinal ligament
and dissected out the ossified common femoral artery. We elevated the
inguinal ligament. We noted that the crossing vein branches were
ateriorized. This was likely a local AV fistula from previous groin
catheterization. These venous branches were ligated and divided with silk.
The artery became soft anteriorly under the inguinal ligament. The
bifurcation was dissected free. The profunda was large. There were two
large profunda branches that were controlled with vessel tapes, and then we
dissected down 3 or 4 inches onto the SFA that was very diseased. 6000
units of heparin were given IV. We occluded the profunda's and the
external iliac artery and made an arteriotomy in the common out onto the
SFA. I did extensive thromboendarterectomy up to the clamp and the
external iliac artery and removed a plug of ossified plaque. I then moved
the clamp down to the common femoral distal to the inguinal ligament and
there was no bleeding from the clamp site proximally. We then carefully
endarterectomized the common into the SFA. We cut the plaque sharply so we
had a nice distal end point. I used 5-0 Prolene tacking stitches in three
spots to tack down the plaque edge. The surface was flushed several times
with heparinized saline. Both profunda branches were widely patent with
huge back bleeding. A bovine patch was brought into the field, cut to size
and sewn in over the defect with 5-0 Prolene. Before the completion of the
suture line we back bleed the SFA. There was excellent back bleeding. It
took a 2-1/2 probe quite easily and a 3. The suture line was completed.
The heparin was reversed with Protamine. We had now a nice pulse in the
proximal SFA and profunda both of which were absent and diminished
respectively. The common femoral artery has a normal pulse. The wound was
irrigated and closed with layers of Vicryl, the skin with clips.
I came up with code 35355. Should anything more be coded, or does that cover it?
Thanks for any and all help!
PROCEDURE: Left iliofemoral endarterectomy with patch angioplasty.
ANESTHESIA: General anesthesia
PROCEDURE IN DETAIL: Antibiotics were given. Time out was called. The
patient was identified. General anesthesia was done. We prepped and
draped in the lower abdomen and legs. I made a vertical groin incision
over the left inguinal ligament, dissected down to the inguinal ligament
and dissected out the ossified common femoral artery. We elevated the
inguinal ligament. We noted that the crossing vein branches were
ateriorized. This was likely a local AV fistula from previous groin
catheterization. These venous branches were ligated and divided with silk.
The artery became soft anteriorly under the inguinal ligament. The
bifurcation was dissected free. The profunda was large. There were two
large profunda branches that were controlled with vessel tapes, and then we
dissected down 3 or 4 inches onto the SFA that was very diseased. 6000
units of heparin were given IV. We occluded the profunda's and the
external iliac artery and made an arteriotomy in the common out onto the
SFA. I did extensive thromboendarterectomy up to the clamp and the
external iliac artery and removed a plug of ossified plaque. I then moved
the clamp down to the common femoral distal to the inguinal ligament and
there was no bleeding from the clamp site proximally. We then carefully
endarterectomized the common into the SFA. We cut the plaque sharply so we
had a nice distal end point. I used 5-0 Prolene tacking stitches in three
spots to tack down the plaque edge. The surface was flushed several times
with heparinized saline. Both profunda branches were widely patent with
huge back bleeding. A bovine patch was brought into the field, cut to size
and sewn in over the defect with 5-0 Prolene. Before the completion of the
suture line we back bleed the SFA. There was excellent back bleeding. It
took a 2-1/2 probe quite easily and a 3. The suture line was completed.
The heparin was reversed with Protamine. We had now a nice pulse in the
proximal SFA and profunda both of which were absent and diminished
respectively. The common femoral artery has a normal pulse. The wound was
irrigated and closed with layers of Vicryl, the skin with clips.
I came up with code 35355. Should anything more be coded, or does that cover it?
Thanks for any and all help!