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Does anyone know the correct way to code this procedure? The Dx is I77.4 Median arcuate ligament syndrome. This was coded with an unlisted code 37799 and equated to 35701.
This was denied and I have not been able to find anyone to assist if this is correct or a correct way of coding it. Here is the op note in case needed.
The lesser omentum was widely fenestrated. The left gastric or coronary vein was identified, and our retroperitoneal dissection proceeded to the medial side of this. The superior border of the pancreas was released inferiorly using the hook cautery. Careful dissection proceeded back toward the celiac axis, and the origin of the left gastric artery and hepatic artery were identified.
With this visualization, the hook cautery was then used to carefully engage and cauterize tissue that was cephalad to the celiac artery. Initially, there was adipose tissue. We encountered obvious celiac ganglion tissue, and we excised a good portion of this as neural mechanisms are thought to participate in the pain associated with her diagnosis. This afforded an excellent view of the median arcuate ligament. This was engaged with the hook cautery, and sideways back-and-forth dissection was used to create a plane between the celiac axis and very dense connective tissue of the median arcuate ligament. It was then very carefully incised using monopolar electrocautery. The phrenic arteries were preserved.
Subsequently, the median arcuate ligament was widely incised approximately 2-3 cm cephalad to the origin of the celiac axis on the aorta, which was cleaned off over its anterior 180 degrees. The aortic crura were identified. We then dissected caudally, again sweeping off the ligamentous and nerve structures from around the origin of the celiac axis until its origin was circumferentially visualized. Hemostasis was noted to be excellent.
This was denied and I have not been able to find anyone to assist if this is correct or a correct way of coding it. Here is the op note in case needed.
The lesser omentum was widely fenestrated. The left gastric or coronary vein was identified, and our retroperitoneal dissection proceeded to the medial side of this. The superior border of the pancreas was released inferiorly using the hook cautery. Careful dissection proceeded back toward the celiac axis, and the origin of the left gastric artery and hepatic artery were identified.
With this visualization, the hook cautery was then used to carefully engage and cauterize tissue that was cephalad to the celiac artery. Initially, there was adipose tissue. We encountered obvious celiac ganglion tissue, and we excised a good portion of this as neural mechanisms are thought to participate in the pain associated with her diagnosis. This afforded an excellent view of the median arcuate ligament. This was engaged with the hook cautery, and sideways back-and-forth dissection was used to create a plane between the celiac axis and very dense connective tissue of the median arcuate ligament. It was then very carefully incised using monopolar electrocautery. The phrenic arteries were preserved.
Subsequently, the median arcuate ligament was widely incised approximately 2-3 cm cephalad to the origin of the celiac axis on the aorta, which was cleaned off over its anterior 180 degrees. The aortic crura were identified. We then dissected caudally, again sweeping off the ligamentous and nerve structures from around the origin of the celiac axis until its origin was circumferentially visualized. Hemostasis was noted to be excellent.