Hello all,
My surgical group recently merged with a group that also has vascular surgeons, and I'm just learning the world of vascular coding. I need help with a code for a brachial artery cutdown and repair, please see the procedure note below:
'Procedure: The patient was prepped and draped. A transverse incision was made in the left arm just above the antecubital fossa. Dissection was carried down to the brachial artery. There was no palpable pulse in the brachial artery. It was freed of attachments and encircled proximally and distally. Procedure was then turned over to Dr. XXX for an attempt at subclavian angioplasty and stend. Following the procedure there was an opening in the brachial artery requiring closure. This was closed with interrupted 7-0 Prolene sutures. The artery was flushed proximally and distally and secured. Hemostasis was adequate. Surgicel was placed over the artery. The wound was irrigated with saline and closed in layers with 3-0 Vicryl and 4-0 nylon. '
Just a nudge in the right direction would be helpful

I would sincerely appreciate if a certified IRR coder/Vascular coder could help someone very rusty on this type coding verify my code choices, please/
I cannot re-copy op note itself, but I verified with thorough op note read these procedures were done as the MD listed them here:
1. Left Lower extremity Third Order angiography 36247-LT
2. Left Lower extremity Third Order angiography S&I 75716 LT
( he cannulated down to anterior tibula artery see note at bottom)
3. Bilateral upper extremity (cephalic vein harvest +35500-50
4. Left External iliac endarterectomy 35351-LT
Left Common Femoral Artery endarterectomy 35372-LT
5. External iliac and common femoral patch angrioplasty
with greater saphenous vein ( included in # 4 CPT codes)
6. Left Common Femoral to anterior tibial artery distal by-pass 35566-LT
with reversed BILATERAL cephaclic veing
( In this procedure the MD took the two cephalic vein pieces
and sewed them together (anatamosis) into one long graft )
_________________________________________________
Are these codes correct please?
Are the modifiers correct ?
Also:
In the body of the op note: the MD also stated I performed bilaterial iliofemoral angioplasty; I then cannulated the left external iliac artery down to the anterior tibial artery
Would I not also code the RIGHT side he did angioplasty on, BEFORE
he went on down to the anterior tibial artery on the left? 36246-59,RT
Thanks for help based on this information alone, as long long op note too much to even put a re-dacted copy here.
Sherry