Ask Dr. Z

"Diagnosis: Left arm AV graft pseudoaneurysm with very thin overlying skin. Procedure: Loopogram with stent placement and revision of left arm AVG. A 5 French micropuncture needle was used to access the AV graft at the apex, and the micropuncture sheath was inserted. A loopogram was performed, revealing the large pseudoaneurysm at the arterial limb. An 8 French sheath was then inserted and exchanged over a J-wire, then a Bentson wire was inserted across the lesion. A 7 mm x 10 cm Viabahn covered stent was deployed across the area of the pseudoaneurysm, and balloon angioplasty was performed. Repeat imaging revealed resolution of the pseudoaneurysm. Wire/sheath were removed. A 4-0 Prolene U stitch on an RB needle was performed. Next, the area of the thin overlying skin was removed in elliptical fashion, and then the healthy skin was closed with 3-0 nylon vertical mattress sutures in an interrupted fashion." Should we code separately for removal of skin, as the stent was placed percutaneously? What code(s) should be used?