Ask Dr. Z

Dr. Z..Can you please help with this endovascular repair? Right and left side common femorals were dissected out and arteries were punctured and guidewires were advanced into the aorta (34812-50 and 36200-50). At this point a retrograde arteriogram was done demonstrating that the iliac arteyr was patent and this probably represented stenosis (yes, he says patent) Patient was systemically heparinized. I made a decision to perform angioplasty of the right and left common iliac arteries to try to assist us in being able to get a device up. Next from the right side an 8 mm stent and the left a 7 mmstent was then placed. and insufflated to approx 8 atmospheres and deflated. Following this a sheath was then placed up into the external iliac artery as far as it could be passed. On the right side, I placed Amplatz wire and used the renal dilators. At this point, I obtained the main body (34802) and was able to advance up into the aorta. Next the pigtail cath was placed on the left and using a series of injections, the main body was deployed to the point that the gate was open. Next on the left side, using a banshee cath, the gate was cannulated and advanced up into the device. a balloon was then placedm, pulled down and appeared to be in good position. arteriogram again (75952-26) a 14 x 11.5 was advanced up into the gate. However, during the deployment it did come down some. therefore to bridge this we placed a 14 x 5.5 which actually fit very nicely. (extension? 34825? 75953-26) deployment was then completed on the right. I shot a retrograde arteriogram on the right and decided to place a 14 x 8.5 (34826? 75953-2659?) The graft was then angioplastied on both sides. Completion angio showed no endoleak however the left internal iliac was no longer visible. We then placed a 8 mm balloon into the left limb of the graft and pushed it up proximally and angio demonstrated the left internal iliac is now patent. Do I have all of the codes that can be charged? is the bridge an extension graft? Thank you for your help!