AHA Coding Clinic® for ICD-9 - 2006 Issue 3; Ask the Editor

Repair of Abdominal Aortic Aneurysm

When the terms “aneurysmectomy” and “dissection” of aneurysm, are documented should these procedures be coded as “excisions?” For example, a patient was admitted with an infrarenal abdominal aortic aneurysm. After extensive lysis of adhesions from a previous colectomy, the neck of the aneurysm was dissected from the surrounding structures in the infrarenal position. A bifurcated graft was trimmed to the appropriate size and sewn end-to-end to both iliac artery orifices. The aneurysmal sac was reapproximated over the graft using sutures. Our surgeons say that the blood vessels of the aneurysm are not “resected” and that the procedures listed in subcategory 38.4X, Resection of vessel with replacement, are obsolete. Some pathology reports even indicate the removal of atherosclerotic plaque and thrombus and not sections of blood vessel walls with aneurysmal lumen. ...

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