Ask Dr. Z

The distal ascending aorta was opened. There was a fragile clot in the distal arch, which was able to be removed with minimal force. There was a small ruptured plaque underlying it. The arch was irrigated and suctioned to remove any residual debris. We elected at this point to cover the ruptured plaque with an endograft. A 26 x 26 x 100 mm Medtronic Valiant endograft was brought onto the field. The Lunderquist wire was passed through the delivery system which was delivered into the visualized aortic lumen and deployed such that it landed in zone 3, just distal to the left common carotid artery. The delivery system was withdrawn. An ophthalmic cautery was used to fenestrate the graft directly opposite the left subclavian artery ostium. Once this was completed, the leading edge of the endograft on the inner curve of the aorta was secured using a 4-0 Prolene pledgeted suture. He would like to bill this as a 33880 and 75956-26 but we wondered if an unlisted code is more appropriate since he was treating thrombus and not an aneurysm?