Head injury, CVA, Vascular Dementia
CVA, Vascular Dementia, Head Injury
Also, was curious about need to add F02.8x with the head injury.
Laureen shows you her proprietary “Bubbling and Highlighting Technique”
Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page 2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers Click here for more sample CPC practice exam questions and answers with full rationale Head injury, CVA, Vascular Dementia
CVA, Vascular Dementia, Head Injury
Also, was curious about need to add F02.8x with the head injury.
Thanks, for any help and/ or input.
If I could get some answers, as well as some pointers on how to determine the correct codes it would be greatly appreciated!!
Procedure in detail: The patient was taken urgently to the operating room and after the induction of satisfactory general LMA anesthesia prepped and draped in the usual sterile fashion in the supine position over the left leg. Initially, a cutdown was performed below the knee on the medial aspect over the saphenous vein, which appeared of reasonable size on a previous ultrasound and carried down to subcutaneous tissues where a very small, sclerotic saphenous vein was in countered. The fascia was then incised and the posterior muscle swept anteriorly ext opposing the distal popliteal artery and carefully D dissecting down along the neurovascular bundle, taking small crossing veins with Ligaclips exposing the trifurcation. There was obvious clot within the trifurcation vessels and the popliteal artery. The femoral cutdown was then performed in the usual fashion with a linear incision controlling hemostasis with the Bovie cautery, and ligated in lymphatics between 2 and 3 0 Vicryl ties until the common femoral, profundus femoris and superficial femoral arteries with her branches were exposed and controlled with vessel loops. The saphenous vein was also observed here and once again was quite small and inadequate for in situ bypass. Lower in the leg the saphenous vein was also exposed down to the level of the ankle and although this was slightly larger there was inadequate length to even bring it above the knee. At this point the patient was systemically heparinized and a linear incision was created over the trifurcation vessels and directed thrombectomy was performed with a significant amount of clot returned. After multiple passages of the 3. Fogarty thrombectomy catheter, bright red blood was retrieved and of further clot was evident. Heparin irrigation was placed down the anterior tibial and posterior tibial arteries and the branches controlled with Yasergil clips. Proximal thrombectomy was also performed an although we were able to get up to the level of the femoral artery where there was a pulse multiple pull-through cyst revealed no evidence of flow. At this point it was decided that the only option was a PTFE graft and a 6 millimeter reinforced graft was selected. After spatula eating the graft, an end-to-side anastomosis was created between the arteriotomy at the level of the trifurcation with a continuous 6 0 Prolene suture. A subsartorial tunnel was created and the graft pulled back through into the femoral incision. Arteriography was performed showing a patent anastomosis with runoff down both vessels to the level of the foot. The proximal artery was then controlled with atraumatic vascular clamps and an anterior arteriotomy measuring approximately 2 and 0.5 centimeters was performed. There was a significant amount of calcific plaque in the posterior portion the artery in endarterectomy was performed with the Freer elevator. This was irrigated aspirated and particulate matter was completely removed. After spatula eating the proximal graft an end-to-side anastomosis was created with a continuous 5 0 Prolene suture. This was 1st opened into the superficial femoral artery and then into the from the and the graft. There was a palpable pulse in the distal graft and the vessels just below this. There was an excellent, biphasic to triphasic Doppler signal. A biphasic Doppler signal was also found at the posterior tibial artery at the ankle. Hemostasis was controlled with the thrombin anticoagulant 2 large Jackson-Pratt drains were placed in the upper lower incisions and secured with silk sutures. The wounds were closed with continuous 2 and 3 0 Vicryl sutures for the deep and subcutaneous tissues and a surgical stapling device for the skin.
Attention was then turned to the right below-knee amputation that had been traumatically opened in a fall. This was prepped and draped with Betadine and 3, 3 0 Prolene sutures were used to partially coapted the skin. Bacitracin ointment and sterile dressings were placed on the incisions. Occlusive bandages were placed on the left leg. The patient tolerated the procedure satisfactorily and returned to recovery in stable condition with all final
Thanks for all and any help!! 😮
Jodi
PREOPERATIVE DIAGNOSES:
1. Rutherford class IV claudication with ABI on the left of 0.47.
2. Asymptomatic carotid disease.
HISTORY: This very pleasant 69-year-old white male with past medical
history significant for peripheral arterial disease in the form of
asymptomatic carotid stenosis who reports that he has had pain in his left
leg for some time that has now become started to come on at rest. The pain
is in his foot in the left calf and he does have rest pains with this. ABIs
were performed that showed ABI of 0.47 in the left leg. He is on aspirin
and statin therapy. He does not smoke and as such invasive peripheral
angiography was performed with possible intervention.
PROCEDURES:
1. Aortogram with runoff.
2. Failed ipsilateral retrograde recannulation of a common iliac stenosis.
DESCRIPTION OF THE PROCEDURE: The patient was brought to the cardiac
catheterization lab after informed written consent was obtained. He was
prepped and draped in the usual sterile fashion with special attention to
the right and left groin. The patient was sedated with Versed and fentanyl,
and using ultrasound guidance, fluoroscopic guidance and micropuncture,
right femoral artery access was obtained with one front wall puncture under
ultrasound guidance and a 5-French femoral sheath was inserted. An
Omniflush was inserted into the right femoral artery and advanced to the
infrarenal abdominal aorta and digital subtraction angiography was
performed. A left common iliac occlusion that was rather short nature was
identified and as such intervention was attempted. Using ultrasound
guidance and micropuncture, a left femoral arterial access was obtained and
a 6-French sheath was inserted using standard technique. Next, a Glidewire
and a Seeker catheter were used to try to in retrograde fashion recannulate
the CTO of the left common femoral; however, we got in the subintimal tract
and the procedure was aborted. Digital subtraction angiography at the end
of the procedure showed that all branch vessels that were previously present
were still accounted for. There was good collateral flow to the left common femoral artery
and the right common iliac and infrarenal aorta were intact
and unchanged from previous. Manual 20 mg of protamine were given to
reverse heparin. Manual pressure was held on the right 5-French common
femoral arteriotomy site until hemostasis was obtained and the left was
successfully Perclose. The patient exited the peripheral vascular lab in
stable condition with no immediate complications.
FINDINGS:
1. Infrarenal abdominal aorta, that is moderately calcified, but patent
with moderate stenosis.
2. The right common iliac has moderate diffuse disease, but is patent.
3. The right internal iliac is patent with moderate disease.
4. The right external iliac is patent with moderate disease.
5. The right common femoral is patent with moderate disease.
6. The left common iliac is occluded. There is a small stump proximally
and there is approximately 7 to 8 cm occlusion which then reconstitutes via
collaterals into the external and internal iliac arteries which are patent
with moderate disease.
ASSESSMENT:
1. Occluded left common iliac with small proximal stump off of the aorta,
failed retrograde ipsilateral recannulization.
2. Otherwise, moderate peripheral arterial disease.
3. Successful StarClose of the left femoral arteriotomy and manual pressure
right femoral arteriotomy.
Thanks,
Kayla