Question

PREOPERATIVE DIAGNOSIS: Symptomatic right internal carotid artery stenosis.

POSTOPERATIVE DIAGNOSIS: Symptomatic right internal carotid artery stenosis.

OPERATIVE PROCEDURE:
1. Right carotid thromboendarterectomy with patch placement. 2. Intraoperative electroencephalogram monitoring.

INDICATION: This 30-year-old woman has a tight right internal carotid artery stenosis. She has had an episode of amaurosis fugax. She has some other medical problems that also complicate her overall situation, but she has a significantly tight stenosis that is symptomatic, and I would recommend an endarterectomy for this. The procedure, along with the risks, has been previously discussed with the patient. Please see the clinic notes. We will be doing this with the patient awake. We also will be doing EEG monitoring though because of the patient’s overall condition, and if she does not end up needing to be intubated during the middle of the case, we will still be able to monitor her brain activity.

PROCEDURE: This was done with the patient under cervical block. Local anesthesia was also infiltrated (0.5% Marcaine with epinephrine). Dissection was carried down through a cervical oblique incision along the anterior border of the sternocleidomastoid muscle. Dissection was carried down to the carotid artery. The common carotid as well as the internal and external carotid arteries and superior thyroid arteries were all dissected free sharply and circumferentially controlled with vessel loops. The common carotid was controlled with umbilical tape and Rumel tourniquet. The patient was systemically heparinized. ACTs were obtained and followed. The ICA was occluded, then the common and then the external carotid. Arteriotomy was made. The plaque was hemorrhagic and ulcerated. It was quite friable. We were able to dissect this out with Freer elevator. This came out quite nicely. The distal endpoint feathered off nicely, but we did place one single tacking suture at the 6-o’clock position. This was 7-0 Prolene. We then used the Impra carotid patch to close the arteriotomy site. This was done with a CV-7 Gore-Tex suture in a running fashion. We heparinized, backbled, and forebled. Intermittently, we had her move her left hand during the case. After suturing the suture line, we opened up the external carotid and the common carotid. After about 10 heartbeats, we then opened up the internal carotid artery. There was bleeding from needle holes. This was controlled with FloSeal. There was good flow through all the arteries at the end of the procedure by Doppler. A 10-mm flat Jackson-Pratt drain was placed before closure of the wound. Hemostasis was present. At the end of the procedure in the admit room, she was awake and following commands and moving all of her extremities. She went to the recovery room in stable condition. I met with the patient’s family postoperatively to discuss the operation.
ADDENDUM: It should be noted that this procedure was done with intraoperative EEG monitoring. No changes were noted in the EEG during the procedure. Clamp time was 40 minutes. A patch closure was used as noted. She was also reversed with 40 mg of protamine at the end of the procedure.

CPT Code: _________

CPT Code: _________

ICD-10-CM: _________

Answer 1

ICD -10-CM code is the tenth version of international classification of disease . These codes are used by the physicians , health care workers and insurance company to represent a diagnosis or disease condition for reimbursement purpose .

CPT code is the current procedural terminology . These codes are used to represent a procedure.

ICD code for Symptomatic right internal carotid artery stenosis is I65.21

CPT code for Right carotid thromboendarterectomy with patch placement is 35301

CPT code for Intraoperative electroencephalogram monitoring is 95816