The patient had a history of coronary artery disease (CAD) status post coronary artery bypass graft (CABG) and was admitted for non-ST elevated myocardial infarction (NSTEMI). Diagnostic left cardiac catheterization revealed pseudoaneurysm of saphenous vein graft of the diagonal artery and coronary occlusion (atherosclerosis) of the vein grafts. The patient underwent selective saphenous vein graft angiography, aortogram and coil embolization of pseudoaneurysm. During the procedure, balloon angioplasty was performed to advance the sheath. The coil was introduced through a catheter and complete thrombosis of the pseudoaneurysm was accomplished via coil embolization. How should this case be coded?
Assign code 410.71, Subendocardial infarction, initial episode of care, as the principal diagnosis for the NSTEMI. Assign codes 996.72, Other complications of internal (biological) (synthetic) prosthetic device, implant, and graft, Due to other cardiac device, implant, and graft, for the pseudoaneurysm of the saphenous vein graft to the diagonal vessel, E878.2, Surgical operation and other surgical procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at the time of operation, Surgical operation with anastomosis, bypass, or graft with natural or artificial tissues used as implant, and 414.02, Coronary atherosclerosis, Of autologous vein bypass graft, as additional diagnoses.
Code 414.11, Aneurysm of coronary vessels, is not appropriate since the aneurysm had developed in an autologous vein graft, not in the native coronary vessels. Although there is a note under category 996.7 indicating that an additional code should be assigned to identify the complication, in this case no additional code is assigned because there is no code to identify the complication of a pseudoaneurysm of an autologous vein graft.
For the procedures, assign codes 39.79, Other endovascular repair (of aneurysm) of other vessels, for the coil embolization, 00.66, Percutaneous transluminal coronary angioplasty [PTCA] or coronary atherectomy, for the angioplasty, 00.40, Procedure on single vessel, 37.22, Left heart cardiac catheterization, 88.42, Aortography, and 88.49, Arteriography of other specified sites.