Ask Dr. Z

I'm unsure on what to code for the chemical thrombectomy in the following case?  "Using SL10 and SynchroSoft, the left posterior communicating artery aneurysm was accessed, and multiple coils were deployed successfully, and the purpose was to partially thrombose the aneurysm. Then using Marksman and SynchroSoft, the pipeline stent was deployed successfully across the aneurysm and below the bifurcation. This pipeline measured 4.0 x 18. At the final deployment, we noted that at the middle of the stent, it was narrowed as a sand hourglass. We did multiple attempts to open this stent; however, we were unsuccessful. At one point, the ICA was completely occluded and that was for only about 30 minutes to 40 minutes. We were able to finally use a balloon and were able to angioplasty the stent and open it up completely. At the end, the aneurysm was at a stagnant flow, and there was filling of both the ACA and MCA as a baseline. There was no extravasation except for a small fistula created between the carotid and the cavernous sinus. There was also no hyperemia or pathologies noted."