AHA Coding Clinic® for HCPCS - 2023 Issue 3; Ask the Editor

Laparoscopic median arcuate ligament release

A patient with median arcuate ligament syndrome presented for release of the median arcuate ligament. A laparoscopic port was placed, and pneumoperitoneum was established. Through robotic ports, dissection was carried down to the junction of the right and left portions of the diaphragmatic crus around the esophagus. The aorta appeared to be covered by a dense layer of muscular tissue consistent with the patient’s diagnosis. Dissection was carried down to locate the celiac trunk. All the investing tissue over the celiac was elevated off the vessel and divided with bipolar cautery to expose the celiac trunk surface. The arcuate ligament was found to be impinging upon the vessel and was therefore elevated off the underlying celiac trunk and divided with cautery. Additional tissue overlying the celiac artery origin and aorta were elevated and divided with cautery. This fully exposed the celiac trunk and several centimeters of the aorta appearing to relieve the impingement completely.There does not seem to be a CPT code to report a laparoscopic median arcuate ligament release. How is this procedure reported? ...

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