deeva456
Expert
Hi, learning vascular surgery and I'm not quite sure which bypass graft code to use.
So far I have coded 36005, 75820-26 & 75825-26. Am I missing anything else, beside the graft codes?
Thank you!
BRIEF SUMMARY: The patient was taken to the operative suite,
received a general anesthetic with LMA airway. Sterile prep and
drape of the right axilla using the ultrasound with probe and a
sterile sleeve, micro catheter was placed in the axillary vein and
passed into the subclavian vein. A contrast venogram performed
through this catheter demonstrated patent I suspect axillary and
subclavian vein with occlusion of the distal superior vena cava. No
contrast was seen to enter the heart, but contrast was seen in the
accessory venous complexes and the mediastinum. Because of this, an
arteriovenous access in the right arm was no longer entertained as a
possibility. The patient then had the right leg prepped and draped
in a sterile fashion. An incision was made overlying the path in
the common femoral artery and vein. These structures were both
identified and mobilized. Dissection of them was somewhat difficult
because of the prior vascular access procedure. However, they were
both found to be patent and sufficient length was mobilized to allow
another arteriovenous access in this location. A prior PTFE graft
was encountered. This was debrided to near the anastomosis on the
venous and arterial sides and the body of the graft was removed. It
was only loosely adherent to the subcutaneous tissue. It was
cultured, but did not look infected. The patient then had a bovine
graft. This was tunneled in a loop fashion on the anterior surface
of the thigh, and then trimmed and anastomosed end-to-side to the
brachial artery, and end-to-side to the brachial vein. Occluding
devices were removed. Flow was present. Wounds were hemostatic,
closed with 3-0 Monocryl and staples. No complications were
encountered, and the patient tolerated procedure well.
So far I have coded 36005, 75820-26 & 75825-26. Am I missing anything else, beside the graft codes?
Thank you!
BRIEF SUMMARY: The patient was taken to the operative suite,
received a general anesthetic with LMA airway. Sterile prep and
drape of the right axilla using the ultrasound with probe and a
sterile sleeve, micro catheter was placed in the axillary vein and
passed into the subclavian vein. A contrast venogram performed
through this catheter demonstrated patent I suspect axillary and
subclavian vein with occlusion of the distal superior vena cava. No
contrast was seen to enter the heart, but contrast was seen in the
accessory venous complexes and the mediastinum. Because of this, an
arteriovenous access in the right arm was no longer entertained as a
possibility. The patient then had the right leg prepped and draped
in a sterile fashion. An incision was made overlying the path in
the common femoral artery and vein. These structures were both
identified and mobilized. Dissection of them was somewhat difficult
because of the prior vascular access procedure. However, they were
both found to be patent and sufficient length was mobilized to allow
another arteriovenous access in this location. A prior PTFE graft
was encountered. This was debrided to near the anastomosis on the
venous and arterial sides and the body of the graft was removed. It
was only loosely adherent to the subcutaneous tissue. It was
cultured, but did not look infected. The patient then had a bovine
graft. This was tunneled in a loop fashion on the anterior surface
of the thigh, and then trimmed and anastomosed end-to-side to the
brachial artery, and end-to-side to the brachial vein. Occluding
devices were removed. Flow was present. Wounds were hemostatic,
closed with 3-0 Monocryl and staples. No complications were
encountered, and the patient tolerated procedure well.