Ask Dr. Z

Dear docs-I was hoping you could help with when can you charge ballooning the iliac for an EVAR placement (and anything else I might be missing)Can I charge 37220 for stenosis when I am not sure that this isn't just for the clearing the way for deployment? And is there really an extension being placed? (including preop discussion, hopefully that helps) In the office in the preoperative area, we had a discussion with the patient regarding the difficult nature of the aneurysm including poor iliac access, high-grade stenosis of the iliac and the need for fem-fem bypass graft. We explained the creation or placement of an aortomonoiliac bypass graft with a fem-fem crossover. Bilateral groins were opened in a vertical fashion. We dissected down to the common femoral, profunda femoris, superficial femoral artery junction. 34812-50 I cannulated the right common femoral artery without complications or difficulty and inserted a wire into the aorta. This was followed by a sheath, flush catheter and then the wire was switched out for stiff wire. Catheter and wires were removed as needed to perform angiography. Please recall that the left common iliac artery is completely occluded. 36200-59RT We performed balloon dilatation of the external iliac artery prior to deployment of the stent graft. 37220-LT The patient was heparinized prior to any ballooning and we planned for the placement of a distal extension and this was carried out by placing a 1610 limb with 124 length in the aneurysm sac and out into the common iliac artery through preexisting stents. 34825/75953-26 A 20 20, 82 limb was then placed with sufficient overlap with the 10 16, 124 graft and finally an Endurant cuff, which was a 32 32 x 49 was placed in an infrarenal location. 34802-75952-26? Completion angiography demonstrated patent renal arteries bilaterally, no evidence of endoleak and widely patent aorto-mono-iliac bypass graft. Having this in mind, we removed the wires, catheters and sheaths and tunneled a piece of 8 mm ringed Gore-Tex from one incision to the other, created arteriotomies on the common femoral arteries and performed anastomosis of the end of the 8 mm bypass graft to the side of the common femoral artery with 6-0 Prolene suture. 34813 thank you so much for your expert opinion!!