AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2024 Issue 2; Ask the Editor
Ascending Aorta and Total Aortic Arch Repair with Extension Frozen Elephant Trunk
The patient underwent open repair of the ascending aorta and total aortic arch with an extension frozen elephant trunk. During surgery, the ascending aorta and proximal arch were excised and a GORE® conformable thoracic stent graft was advanced into the ongoing aorta and deployed in Zone 1. It was fenestrated on-table according to the branched stented anastomosis frozen elephant trunk repair (BSAFER) technique, with a Fluency™ stent graft deployed into the left subclavian artery (LSA), and a Viabahn® stent graft deployed into the left common carotid artery (LCC). The innominate artery was maintained as an island implanted directly to the graft. A Gelweave™ graft was trimmed and sewn end to end to the ongoing stented aorta. The aorta was de-aired and systemic flow resumed. Appropriate flow in the descending aorta was confirmed by transesophageal echocardiogram, and rewarming begun. The graft was then trimmed and sewn end to end to the sinotubular junction. How should this case be coded? ...
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Article Overview
This premium article describes a complex open thoracic aortic repair that combines ascending aorta and total arch reconstruction with endovascular components and branch-vessel management. It is intended for coding and reimbursement professionals who need to understand the operative scope, the devices and vascular territories involved, and the general procedural context for assigning procedure codes.
Why This Topic Matters
Complex hybrid aortic repairs often involve multiple operative components, device placements, and anatomic zones, making accurate interpretation important for procedure coding and documentation review.
What You Will Learn
- The overall operative approach used in a complex thoracic aortic reconstruction
- How the repair combines open surgical and endovascular components
- Which major thoracic aortic and branch vessel territories are involved
- The types of devices and grafts mentioned in the operative narrative
- Why this type of procedure requires careful coding review
Who Should Read This
- Medical coders
- Coding auditors
- Clinical documentation specialists
- Cardiovascular surgery billing staff
- Revenue cycle professionals
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