[Verified Answer]: Case 1: Operative Report Note: Do not code…

Case 1: Operative Report Note: Do not code angiography on this case. DIAGNOSES: Severe right common carotid stenosis, multiple recurrent episodes of left-side weakness and transient ischemic attack OPERATIONS PERFORMED: Right common carotid percutaneous stenting using an Abbott emboshield distal protective device with Abbott self-expanding stent, 6 to 9 mm tapered stent by 4 cm INDICATION: A 66-year- old male patient who had multiple medical problems and had recurrent left arm and leg weakness and repeated episodes of transient ischemic attack with a high grade right carotid stenosis. He was discharged from another hospital recently for what was believed to be syncope, but it turned out that he was having recurrent transient ischemic attacks and left-sided weakness. His CT scan preoperatively did not show any acute stroke. OPERATIVE FINDINGS: Carotid angiographic findings showed today that the patient had a near occluded right carotid artery. The arch was a type 1 arch, but the findings were significant for very high grade stenosis. DESCRIPTION OF OPERATION: With the patient in supine position, both groins were prepped and draped sterilely. The common femoral artery was accessed with an 18-gauge needle J wire and a 5-French sheath. Using a Storz wire, this was advanced to the aortic arch. Under C-arm fluoroscopy guidance, a 100-cm pigtail catheter was placed in the ascending aorta and arch aortogram was performed, identifying the innominate artery and other arch vessels. This was a type 1 arch and the right innominate artery was isolated with the JB1 guide Cath. The wire was then exchanged for a Rosen wire and then a 6-French sheath was placed. This is a Terumo destination sheath, placed over the Rosen wire up to the common carotid artery. The C-arm image was then centered under magnification level 1, to be able to see the sheath as well as the distal internal carotid artery for the placement of the distal embolic protection device. The patient was then fully heparinized. ACT goal was greater than 300. The patient was given at least 2 boluses of heparin to achieve full anticoagulation. The wire was carefully maneuvered to pass across the very high grade, tight stenoses and the wire was placed up in the distal internal carotid artery. The distal embolic protection device was then placed through the lesion and the basket was carefully opened up in the distal internal carotid artery. Pre-dilatation was then performed with a 4-mm balloon and this was subsequently removed and the stent was deployed. This was a 9-mm proximal stent with a distal stent of 6 mm that was deployed in good position. Multiple angiograms were taken at this time to assure the placement. After the placement, the stent was post-dilated with a 5-mm balloon × 2 cm. This was ballooned at 2 sites successfully. Completion angiogram showed a widely patent stent and a widely patent distal embolic protection device. After the post-dilatation of the stent, the balloon was removed. The distal embolic protection device was recaptured and removed carefully. The sheath was removed and the Angio-Seal was placed to close the right groin puncture site. The patient tolerated the procedure and was taken to the intensive care unit for monitoring. Find the ICD-10-PCS code for this Case