Ask Dr. Z

Co-surgery with urologist. Summary of vascular report: "I completely excised the tumor, leaving a very small rim of tumor in the cava. Once the left kidney was off the field, I was then able to place clamps in the renal vein, in the cava above and below the tumor, and finally was able to excise the rim of cava that was invaded with tumor. We were able to completely resect the tumor from the cava. We attempted a primary repair, but it was evident that a mismatch in size occurred. For this reason, I decided to patch the cava using bovine pericardium. A bovine pericardial patch was then shaped, cut, and anastomosed to the defect using 3-0 Prolene sutures, and with the aid of loupe magnification. Prior to completing the repair, we back-bled and flushed inflow and outflow sources, copiously irrigated the cava, and finally completed the repair." How should the repair (MD calls it a reconstruction) be reported: 35281 or 34502?