Ask Dr. Z

For this case, is it possible to bill 33853 with 33854?  The physician actually extended the graft to the distal arch because it was hypoplastic, so I wanted to know if I could bill both codes under these circumstances.

Procedure performed open repair of coarctation PROCEDURE NOTE: A left-sided posterolateral thoracotomy was made. The distal aortic arch and proximal descending thoracic aorta were mobilized. The Control of the distal aortic arch and subclavian artery was obtained. CPB was utilized. The coarctation was then resected and sent to pathology. In order to sew a larger graft to the distal arch, the arch was opened up into the left Subclavian and a 22 mm graft was then sewn to the distal aortic arch and subclavian. The graft was then trimmed to size and sewn to the descending thoracic aorta distal to the aortic coarctation Interposition graft was approximately an 4 cm long. FINDINGS: His distal aortic arch was hypoplastic measuring approximately 18 mm between the carotid and the left subclavian. The aortic coarctation was distal to the left subclavian in the isthmus area. We resected the coarctation area and performed an end-to-end anastomosis with interposition graft and 22 mm Dacron graft.