I am new to EVAR coding and need confirmation that I am coding this report appropriately. My provider uses the term "extension" in his report, but I don’t think that it is truly an extension that I can code for as it does not appear that it is placed distal to the common iliac artery. I came up with CPT 34705-62 for this report. Please confirm.

Pre-Operative Diagnosis: Abdominal Aortic Aneurysm
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Post-Operative Diagnosis: Successful Endovascular AAA Stent Graft Placement
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Abdominal Aortogram, Bilateral Iliac Angiogram and AAA Stent Graft Placement
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INDICATION FOR PROCEDURE:
Infrarenal abdominal aortic aneurysm more than 5 cm in diameter
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Nature of procedure, including benefits, alternative and risks, e.g. bleeding, CVA, MI, renal failure, infection, emergency CABG and even death explained.
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CO-SURGEON: Dr. XXXXX and Dr. XXXXX
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CONTRAST:
* Intraprocedure medication information is unavailable because the case start and end events have not been set *
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NAME OF PROCEDURE:
1. Insertion of bilateral arterial sheath and catheter placement via both femoral arteries.
2. Abdominal aortogram with bilateral selective iliac angiogram to facilitate stent graft placement.
3. Placement of a Cook Zenith AAA stent graft main body by flex flex body 30×111 mm device via the left groin.
4. Placement of a contralateral limb via the right groin using a Cook Zenith spiral limb extension 20×74 mm iliac limb.
5. Placement of a left iliac limb extension using a Cook Zenith spiral limb extension 11 X 74 mm iliac device.
6. Balloon angioplasty of all stent graft anastomosis site using a Coda balloon.
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DESCRIPTION OF PROCEDURE:
After an informed consent, the patient was brought into the cath lab and prepped and draped in the usual fashion. General anesthesia was administered by anesthesiologist and the anesthesia record will be reported separately.
Bilateral femoral artery cutdown was performed by Dr. XXXXX. His cutdown report will also be dictated separately.
After bilateral arterial cutdown, bilateral 7-French sheath was placed under Seldinger technique under open condition without complication. Bilateral arterial catheterization was performed using a soft Glidewire and then exchanged out for 2 stiff Lunderquist guide wires. A 6-French Royal Flush pigtail catheter was advanced from the right groin into the abdominal aorta above the renal arteries. Suprarenal abdominal aortogram was performed to evaluate position of the renal artery so as to use it as a landmark for stent graft placement. The left renal artery appeared to be the lower vessel and was used as a landmark. Subsequently, a Cook Zenith main body 30×111 mm Tri-Flex flex body device was advanced from the left groin into the abdominal aorta at the junction of the left renal artery. Prior to that slow subsequent dilatation was done with 16, 18 and 20 mm dilator Slow deployment was performed where we were able to precisely place the stent graft below the left renal artery as well as to allow the contralateral limb to open up toward the anterior projection. Subsequently, we were able to exchange out for a soft wire and a Headhunter catheter to access the contralateral limb from the right side without difficulty. Confirming position of the wire into the main body from the contralateral limb using a pigtail catheter, we were able to measure the size and the length of the device that we need. After insuring that we were truly in the true lumen of the contralateral limb, we were able to deliver a 20×74 mm Zenith spiral limb extension contralateral limb device with at least 1 to 1-1/2 graft overlap distally without occlusion of the internal iliac artery. The right limb deployed slowly without complication.
After the rest of the main body limb was fully deployed on the left side, the pigtail catheter was exchanged out in the left side. Left iliac angiogram was subsequently performed where we were able to precisely locate and measure the size of the device we need for the right limb extension. After measuring the length, we were able to determine that a 11×74 mm Zeta spiral limb extension iliac limb distention was needed for the left-sided. Subsequently the 11×74 mm left iliac limb extension was advanced and deployed with 1 to 1-1/2 stent overlap into the main body and with good opposition of the distal side without occlusion of the internal iliac artery. After all stent grafts were deployed, at that point, we used a Coda balloon and inflate all attachment sites using the Coda balloon at low pressures. The ostium of bilateral iliac artery needed to be further dilated with 10×40 mm peripheral balloon Subsequently, angiography was performed which demonstrated excellent main body main AAA stent graft position without occlusion of the renal artery. There was no endoleak seen by the lumbar vessel, which is not significant. At that point, both cutdown sites were repaired by Dr. XXXX and Dr. XXXXX without complication. The patient was subsequently gradually recovered from anesthesia and was transferred to recovery room in stable condition.
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FINAL IMPRESSION:
Successful placement of a Zenith AAA endograft with main body through the left side with bilateral iliac extension was performed without complication.
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FINAL DIAGNOSES:
Successful abdominal aortic aneurysm sealed with endovascular graft with bilateral iliac limb extension
RECOMMENDATION:
Recommend routine post-aortic stent graft monitoring. Will followup CT with ultrasound in 3 months and yearly as indicated to rule out endoleak.