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Resolved Graft Bridging

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KimM_73717

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Primary procedure is 33880
Documentation states "Graft bridging from the proximal thoracic endograft to the distal abdominal endograft." Is this part of the repair itself, is the surgeon connecting the 2 together? Is there a separate code to bill?
 
The procedure includes placement of the initial endoprosthesis plus descending thoracic aorta extensions to the level of the celiac artery if needed. Endovascular repair of the descending thoracic aorta may be used to treat an aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma or traumatic disruption. An access artery, usually the femoral or iliac, is punctured and a flexible guidewire passed in a retrograde fashion into the ascending aorta using separately reportable fluoroscopic guidance. The contralateral femoral or iliac artery is punctured, a sheath placed and a second guidewire passed into the ascending aorta. An aortogram is obtained and the aneurysm evaluated. An ultrasound probe is introduced and the aneurysm measured. A properly sized stent-graft (endoprosthesis) is selected. One of the flexible guidewires is removed and exchanged for a stiff guidewire. One of the sheaths is removed and exchanged for an introducer sheath. The stent-graft is loaded and maneuvered into position. Another aortogram is obtained to verify correct positioning of the stent-graft. The stent-graft is deployed. The distal and proximal ends of the stent-graft are ballooned and sealed. Stent-graft extensions to the level of the celiac artery are loaded, positioned and deployed as needed. The overlapping segments of stent-graft extensions are ballooned and sealed. Another aortogram is obtained to verify complete exclusion of the defect in the descending thoracic aorta and to check for leakage at the distal and proximal ends of the graft or stent. In 33880, the aneurysm extends beyond the origin of the subclavian artery and the stent-graft covers and occludes the left subclavian artery. In 33881, the aneurysm does not extend to the level of the subclavian artery and the subclavian artery is not occluded by the stent-graft.
 
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