Ask Dr. Z

I code for both the primary and assistant surgeons. The primary surgeon from the first procedure was the assistant for the second and visa versa. How do you code one procedure that turns into two, that stretches from 7:45 am to after 4:30 pm on a patient that exceeded 400 lb? They did a bilateral femoral artery cutdown, with attempted deployment of aortobiiliac unibody graft. They added a micropuncture to the left brachial artery for additional access. In addition to the patient’s size he also had severe tortuosity of both iliac arteries with at least two 90 degree bends. They had difficulty unsheathing the right limb, and after many attempts to unsheathe the limb and a broken wire, they decided to move to the OR where they performed an open AA aneurysmorrhaphy with aortobiiliac bypass. After thoughtful research I feel that the following is correct, but I would like a second opinion. Surgery 1: 34812-50, 36200-RT, 36200-59LT, 34804-53, 75952-26. Surgery 2: 35102-2278. One of my concerns is that code 35102 will be bundled into code 34804 due to NCCI edits.