how would you code the following op report? Incision carried thru groin and exposed the common femoral to the level of theinguinal ligament, which was displaced and partially split to allow for external iliac to be encircled with vessel loop and then, the profunda and superficial femoral was done. There is aneurysm 2.5 to 3 cm diagnoally in the common femoral artery with very thing wall medial posteriorly. A starter needle gauge 18 was inserted and guidewire inserted and we had to switch it to a Glidewire, negotiated the tortuous iliac and passed to the level of the aneurysm. The sheath 7 mm was inserted. Angiogram was obtained, delineating the are of the aneurysm and also partial dissection along that area. Stents were deployed overlapping, the 8mm first then the 9mm was exteded into the proximal part, ballooned it with the 8 x 14 ballon. Completion angiogram showed good seal with no leakage and complete repair. The wire was removed, sheath removed. Porximal and distal control. Arteriotomy was performed. organized clots werre removed from the aneurysm. aneurysm walls were cut and prceeded with an endarterectomy in the superficial, femoral and profunda and then the reconstruction was done with a bovine patch, secrued with prolene and hemostasis secured.
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About this Question
- Posted by Christine Burgan 4 months ago. There are 7 posts. The latest reply is from SuperCoder.
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Hi Christine,
I forwarded your question to the Cardiology Coding Alert editor. I'll let you know what she says!
Suzanne
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These type of procedures give me a hard time. I came up with the highest procedure code for anesthesia being 01924, but I just want to be sure it isn't 00880. The fact than an incision is made to access the vein is what confuses me. Is it considered open even if the vein is just punctured or not???? I've seen it billed several ways and don't know which is correct. Thanks for helping, I'll await your next response.
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Have you gotten a response yet?
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Hi, Christine: This appears to be "open" based on the exposure and displacement of the iliac as well as the later arteriotomy and reconstruction. Interventional procedures do involve going through the skin to puncture the vein (allowing access for catheters and the like), but they don't involve large incisions for direct access. Guidewires and angiography can still be performed in cases where a physician uses open access to get to the vessel. I hope that helps! -Deborah
Deborah Marsh, JD, MA, CPC, CHONC
The Coding Institute -
sorry to sound stupid, but would that make it "00880"? or "01926"?
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Hi, Christine, and my apologies for the delay. I started researching this for you yesterday and then my Internet went down. And, just for the record, there are no stupid questions here -- we're all doing our best to code things correctly.
From what you included above, it looks like the aneurysm removal from the femoral artery was the main procedure done during the encounter. As anesthesia coders, we have to figure out the correct surgical code so we can trace it back to the correct anesthesia code. You'll want to take another look at the documentation, but I'm thinking the surgical code might be 37226 (which includes stent placement). If so, the primary anesthesia code it crosses to is 01924, at 6 base units. Alternate anesthesia codes are 01270 or 01440, which each carry 8 base units.
Show these options to your physician along with the documentation. He or she should be able to help you decide which of the options is the best fit.
I hope that helps!Leigh DeLozier, CPC
Editor, The Coding Institute
SuperCoder Member
