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Exploratory laparotomy; exploration of AAA sac with evacuation of contents

Date: Jan 9, 2023


"Pt has distant history of open retroperitoneal AAA repair. Aneurysm sac has gotten larger over the years and now presents with abdominal, back, and groin pain. Surgeon is concerned the aneurysm sac enlargement is related to these symptoms. Exploratory laparotomy with exploration of the AAA sac and evacuation of contents and control of bleeding performed.

Midline laparotomy incision was made. The aneurysm sac was evident, intestines retracted appropriately, posterior peritoneum was incised and aneurysm sac dissected free. Aneurysm incised, fluid came out under pressure with blood clot component, cultures taken. Contents of aneurysm evacuated and retractors placed. Evidence of arterial bleeding from lumbar vessels, these were suture ligated. Hemostasis assured. Aneurysm sac reclosed with running Vicryl along with posterior peritoneum."

What CPT codes would you use to code this case? I was thinking 49000 (exploratory laparotomy) and 35221 (repair blood vessel), or would an unlisted procedure code be best? 

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