Ask Dr. Z

I need help coding a procedure that my physician performed. Would an extension be appropriate to billed in addition to the first stent graft placed? "Pt came in with large saccular aneurysm of the proximal descending thoracic aorta involving the takeoff of the LT subclavian artery. 1St step was to place an Amplatzer plug in LT subclavian to prevent this artery from becoming a source of type II endoleak. From LT femoral approach tip of catheter was advanced into the LT subclavian and into the LT axillary. Plug was deployed proximal to the takeoff of the LT vertebral. Now deployment of the thoracic endograft from RT femoral access a 36x100 thoracic endograft was positioned in proximal portion of the aortic arch at the level of takeoff to LT common carotid making it easier to transverse the aortic arch. Then deployed the graft so the proximal edge was positioned distal to takeoff of common carotid. Unfortunately during this deployment the stent graft jumped at the last moment and landed more distal than planned. It was necessary to place a 2nd thoracic endograft."