AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2023 Issue 3; Ask the Editor

Fenestration of Aortic Dissection Flap

A patient with an acute type B aortic dissection with kidney malperfusion required surgery, which involved fenestration of the dissection flap. Through the right and left femoral arteries, wires were threaded into the true and false lumens. There was significant true lumen compression. Over the two wires, a 6-French Destination sheath was advanced to attempt to fenestrate the dissection flap; however, the false lumen wire prolapsed back into the true lumen with only minimal fenestration achieved. To effectively fenestrate the dissection flap, the left-sided sheath was exchanged and using a Pioneer catheter below the level of the renal arteries, the false lumen was entered with a wire. The 6-French sheath was advanced over the wires to create a fenestration up to just above the level of the celiac artery. A French sheath was further advanced up into the descending thoracic aorta to extend the fenestration. The goal of reperfusing the left kidney with excellent flow and equalizing the pressure between the true and false lumen was achieved. What is the correct ICD-10-PCS code for the fenestration of the aortic dissection flap with extension into the thoracic aorta? ...

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