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Attempted Coiling Procedure?

Jammie Posted Thu 09th of October, 2014 07:02:11 AM

Good Morning,

I am in need of some guidance on the report below:

INDICATIONS
Circumflex artery aneurysm.

OPERATORS
Dr. A (provider in our group)
Dr. B (provider NOT in our group)

PROCEDURE PERFORMED
1. Right groin 6-French retrograde access with a 45 cm sheath into the mid
aorta.
2. Selective saphenous vein graft to the circumflex artery angiography.
3. Attempted coiling procedure deployment into the aneurysm.

CATHETERIZATION REPORT
After informed consent was obtained, the patient was prepped and draped in a sterile fashion on the cath lab table. After injecting 10 mL of 2% Xylocaine
in the right groin, access was obtained via Seldinger technique. Catheters
used were a 6-French short sheath. We had a significantly difficult time
getting the wire into the aortoiliac bifurcation region due to severe tortuosity. At this point, utilizing a straight glide catheter and glidewire, we were able to get the catheter placed in the mid aorta, exchange the glidewire for an 0.035 exchange wire, and at this point, a 45 cm Terumo
braided sheath was placed in the mid aorta. This provided adequate support.
At this point, multiple catheters were attempted to engage the saphenous vein graft ostium. Finally, the catheter that did engage appropriately was the JR5 catheter followed by an AL1 catheter. Both of these catheters engaged the ostium appropriately, and the intervention was started. A Choice PT floppy wire was used to wire the vessel through the SVG graft into the native vessel retrograde to provide support, and Dr. B placed a braided coiling catheter over the wire technique down to the vessel. Multiple attempts were made for the catheter. However, due to lack of support and severe tortuosity, there was a significant amount of pushback to where the catheter did come out of the artery and was not able to traverse successfully. At this point, a Guide Liner catheter was introduced through the AL1 catheter, and buddy wire position was maintained with the choice CT wire which was then changed to a ProWater Flex wire. The catheter was advanced on numerous occasions and unfortunately would not traverse down to the level of the aneurysm. After 66 minutes of fluoro time and repeated attempts, decision was made to remove all equipment and to reevaluate alternative options for the patient.

IMPRESSION
1. Unsuccessful attempt to coil and nebulize circumflex artery large
aneurysm.
2. The right groin 6-French sheath was removed with manual pressure.
3. Will discuss with Dr. Still and the cardiac team in regards to
alternative options.

COMPLICATIONS
None.

SuperCoder Answered Thu 09th of October, 2014 07:39:38 AM

AAE does not provide coding for operative reports and chart notes.

SuperCoder offers SuperCoding on Demand (SOD) (http://www.supercoder.com/coding-answers/coding-on-demand) for coding of an operative report or chart note and you can contact (866)228-9252 or e-mail customerservice@supercoder.com for more information.

Jammie Posted Fri 10th of October, 2014 10:41:48 AM

I see other operative reports on this forum that have had guidance given

SuperCoder Answered Tue 14th of October, 2014 00:00:17 AM

It depends upon the complexity of the note. The above given note can only be considered under SuperCoding on Demand. Also, you have mentioned that you need some guidance, however you are not very specific in your query. Please post a specific question to help us take care of your doubt or query.

Thanks !!

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