ellis3350
Guru
Hello,
When a vascular surgeon is doing an open DVA (35686) that is normally performed when also placing a bypass graft for CLI, performs the DVA with no bypass, what comp code would one suggest for the unlisted 37799? I was thinking maybe 37799 c/w 35226 but wanted to get others thoughts.
I created a 4- to 5-cm vertical skin incision on the medial aspect of the ankle just posterior to the medial malleolus over the previously mapped posterior tibial artery trajectory. The skin incision was deepened through the subcutaneous tissue until the fascia was identified. The fascia was incised, exposing the very distal aspect of posterior tibial artery and veins. A 2-cm segment of the posterior tibial artery was sharply dissected. Crossing venae comitantes were ligated and divided. The adjacent posterior tibial vein was then sharply dissected for a segment of 2 cm. All venous tributaries were controlled with micro clips. The patient was anticoagulated appropriately with ACT levels above 250. The posterior tibial artery and vein were controlled proximally and distally in addition to the branches and tributaries respectively. An arteriotomy was made in the posterior tibial artery using microscopic Beaver blade. The arteriotomy was extended proximally and distally for a distance of 3 cm using microscopic scissors. In a similar fashion, a venotomy was made in the posterior tibial vein using Beaver blade and extended with microscopic scissors. A side-to-side anastomosis was created between the artery and the vein using 7 0 Prolene a running fashion. At the completion of the anastomosis, the created fistula was de-aired, and flow was reestablished into both the posterior tibial artery and vein. Hemostasis was established. Hand-held Doppler was used to confirm adequate flow within the fistula and the arterial branches in addition to the vein tributaries associated with the fistula. The wound was copiously irrigated with antibiotic solution. Hemostasis was confirmed and found to be adequate. The incision was closed using 3-0 nylon in a vertical mattress fashion. Sterile dressing was then applied.
When a vascular surgeon is doing an open DVA (35686) that is normally performed when also placing a bypass graft for CLI, performs the DVA with no bypass, what comp code would one suggest for the unlisted 37799? I was thinking maybe 37799 c/w 35226 but wanted to get others thoughts.
I created a 4- to 5-cm vertical skin incision on the medial aspect of the ankle just posterior to the medial malleolus over the previously mapped posterior tibial artery trajectory. The skin incision was deepened through the subcutaneous tissue until the fascia was identified. The fascia was incised, exposing the very distal aspect of posterior tibial artery and veins. A 2-cm segment of the posterior tibial artery was sharply dissected. Crossing venae comitantes were ligated and divided. The adjacent posterior tibial vein was then sharply dissected for a segment of 2 cm. All venous tributaries were controlled with micro clips. The patient was anticoagulated appropriately with ACT levels above 250. The posterior tibial artery and vein were controlled proximally and distally in addition to the branches and tributaries respectively. An arteriotomy was made in the posterior tibial artery using microscopic Beaver blade. The arteriotomy was extended proximally and distally for a distance of 3 cm using microscopic scissors. In a similar fashion, a venotomy was made in the posterior tibial vein using Beaver blade and extended with microscopic scissors. A side-to-side anastomosis was created between the artery and the vein using 7 0 Prolene a running fashion. At the completion of the anastomosis, the created fistula was de-aired, and flow was reestablished into both the posterior tibial artery and vein. Hemostasis was established. Hand-held Doppler was used to confirm adequate flow within the fistula and the arterial branches in addition to the vein tributaries associated with the fistula. The wound was copiously irrigated with antibiotic solution. Hemostasis was confirmed and found to be adequate. The incision was closed using 3-0 nylon in a vertical mattress fashion. Sterile dressing was then applied.