Any thoughts on coded for this procedure? The only valvuloplasy code I see is on the femoral vein and the aneurysm repair codes are for arteries.
PROCEDURE PERFORMED: Ultrasound-guided access to left posterior tibial vein, left lower extremity venography, posterior approach to left popliteal vein aneurysmorrhaphy and internal valvuloplasty.
We used a curvilinear incision, I dissected down through the subcutaneous tissue and through the fascia following a small short saphenous vein down into the popliteal fossa. The popliteal vein was immediately evident as we entered into the popliteal fat pad. We then dissected this free from surrounding tissue making sure to preserve the tibial and common peroneal nerves.
We were able to dissect both proximally and get a Vesi-Loop around this as well as distally and then we dissected the popliteal vein off the popliteal artery and ligated small branches that were coming off the popliteal vein. We preserved two large branches and Potts tied these with Vesi-Loops. We then heparinized with 100 units per kilogram of heparin and then used an 11 blade and Potts scissors to create our venotomy.
We inspected the venous bed, identified a valve that was very redundant and was noted to be incompetent on previous duplex and tacked this up with a 5-0 Prolene to help try and see if it would maintain competence thus performing an internal valvuloplasty. We then resected some of the vein wall so that we could close the vein without undue narrowing but still have the majority of aneurysm gone. We sewed this up with a 5-0 Prolene in continuous fashion, flushing prior to tying down the anastomosis and then tying down the anastomosis with flow in the vein to avoid pursestringing.
Nicole, CPC
PROCEDURE PERFORMED: Ultrasound-guided access to left posterior tibial vein, left lower extremity venography, posterior approach to left popliteal vein aneurysmorrhaphy and internal valvuloplasty.
We used a curvilinear incision, I dissected down through the subcutaneous tissue and through the fascia following a small short saphenous vein down into the popliteal fossa. The popliteal vein was immediately evident as we entered into the popliteal fat pad. We then dissected this free from surrounding tissue making sure to preserve the tibial and common peroneal nerves.
We were able to dissect both proximally and get a Vesi-Loop around this as well as distally and then we dissected the popliteal vein off the popliteal artery and ligated small branches that were coming off the popliteal vein. We preserved two large branches and Potts tied these with Vesi-Loops. We then heparinized with 100 units per kilogram of heparin and then used an 11 blade and Potts scissors to create our venotomy.
We inspected the venous bed, identified a valve that was very redundant and was noted to be incompetent on previous duplex and tacked this up with a 5-0 Prolene to help try and see if it would maintain competence thus performing an internal valvuloplasty. We then resected some of the vein wall so that we could close the vein without undue narrowing but still have the majority of aneurysm gone. We sewed this up with a 5-0 Prolene in continuous fashion, flushing prior to tying down the anastomosis and then tying down the anastomosis with flow in the vein to avoid pursestringing.
Nicole, CPC