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Removal of graft

Date: Jul 26, 2012

Question:

I have a question for you - One of my resources allows codes 35903, 35286-59, but I am hesitatant to add the patch closure. How would you code the following procedure? Thanks for your help. BILATERAL GROIN INFECTIONS WITH INFECTED FEMORAL-FEMORAL BYPASS GRAFT. The bilateral groins were prepped with a Betadine solution and draped aseptically. I began by aggressive debridement of the obviously necrotic, foul-smelling fatty tissue in the right groin. This was carried down to allow identification of the right limb of the bypass graft. Proximal and distal control were achieved in the femoral artery. Five thousand units of intravenous heparin was administered. The graft was clearly not incorporated in the surrounding tissues. Thus, it was removed from the common femoral artery and the artery was closed in a patch fashion with bovine patch with 5-0 Prolene suture. The groin was then copiously irrigated with a pulse irrigator with 3 liters of normal saline. A layer was closed over the artery and the rest of the groin left open given the presence of the infection and packed with Dakin's soaked Kerlix. Next, attention was directed to the left groin where necrotic tissue was sharply debrided down to healthy granulation tissue. The groin was once again copiously pulse irrigated. Of note, the graft had been removed through the right groin. The pocket was copiously irrigated. The groin was then packed open with Dakin's soaked Kerlix. Sterile dressing was applied.
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