Ask Dr. Z

Should the following be reported with code 37223 or 37236? "Based on the measurements of the previously placed AFX endograft, coverage of the area of leakage would require a 16 mm iliac limb from W.L. Gore and Company. There was a separation endoleak or a type 3 endoleak between the right iliac limb of the AFX device and the previously placed VBX stents extending the repair into the external iliac artery. We decided to put a bridging stent. We placed a 12 French Cook sheath over the stiff wire via the right common femoral artery, which was advanced under vision into the aortic reconstruction. We advanced a Gore 16 x 16 x 11.5 cm covered stent across the area of extravasation. This was then ballooned in place using a 14 x 4 Atlas balloon. Completion angiogram demonstrated excellent result with seal of the area of previous extravasation and good flow down both limbs of the aorto-bi-iliac reconstruction. The right iliac access was closed with an 8 French Angio-Seal device, and angiography revealed satisfactory flow down the right leg. No extravasation at the puncture site was noted."