by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC
Question:
Real-time visualization of the common femoral artery and vein were identified as the artery was accessed. At this time the Neurosurgery team expose the T10 screw and transected the upper segment of the rod and prepared the screw for removal.
Under the protection of a Kumpe catheter a Lunderquist wire was placed into the aortic arch. We upsized to a 16 Fr DrySeal sheath via the left groin. A 28 x 33 mm Gore cuff was advanced to the area where the screw was.
Under fluoroscopic visualization the screw was slowly backed out and the stent graft was deployed over the area where was located. The screw was then ultimately removed with no signs of bleeding.
We exchanged for a flush catheter and two views demonstrated patent stent graft with no extravasation. Perclose devices were tightened over a stiff wire after the sheath was removed with good pedal pulses. Protamine was given.
The remainder of the spine closure was performed by Neurosurgery.
Would you consider this 37236 or 33881 for the stent graft?
Answer:
Since it was for trauma, I would go with 33881, along with S&I, catheter placement, access, etc.
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