Provide the ICD-10-CM/PCS codes and MS-DRG for case study PREOPERATIVE DIAGNOSIS: High-grade asymptomatic right carotid

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Provide the ICD-10-CM/PCS codes and
MS-DRG for case study PREOPERATIVE DIAGNOSIS:
High-grade asymptomatic right carotid artery stenosis.
POSTOPERATIVE DIAGNOSIS: High-grade asymptomatic right carotid
artery stenosis. PROCEDURE PERFORMED: Percutaneous transluminal
angioplasty and stenting of the right internal carotid artery.
(This was done under the Choice protocol.) ANESTHESIA: Local.
INDICATION: The patient is a 72-year-old gentleman who is 10 years
status post head and neck surgery for cancer, status post
radiation, and has a tracheotomy in place. He has developed a
high-grade asymptomatic right carotid artery stenosis. After
reviewing the risks, benefits, and alternatives of his options, he
wished to proceed with carotid artery stenting, due to his high
anatomical risk factors and high risk of nerve injury. He was
enrolled under the Choice post market registry protocol. After the
patient was correctly identified and consented, he was taken to the
cardiac cath lab and placed in supine position. The right groin was
prepped and draped in usual sterile fashion and anesthetized with
1% local. Using anatomical landmarks, the right common femoral
artery was punctured with a micropuncture needle in a retrograde
fashion. A 0.018-inch wire was then passed under fluoroscopy into
the aorta. The needle was exchanged out for a 5-French coaxial
dilator and subsequently for a 5-French sheath. Omni flush catheter
was then taken into the arch in an LAO projection and aortogram was
then performed. This demonstrates a mildly to moderately
atherosclerotic aortic arch without any evidence of stenosis. The
origins of the great vessels are identified, and these are widely
patent without severe disease. The visualized portions of the right
subclavian, vertebral, left subclavian, and left vertebral arteries
are all widely patent without any evidence of severe disease. The
left common carotid artery is patent proximally. The right common
carotid artery arises from the innominate in a normal variant. The
patient was then systemically heparinized, and his ACT was kept
over 220 seconds throughout the entire case. The right common
carotid artery was negotiated and then cannulated with a with a
Bernstein catheter. With a catheter in the common carotid,
angiogram was performed, which demonstrates a high-grade
atherosclerotic lesion of the proximal right internal carotid
artery MAC with 80-90% stenosis. Distal to this, the artery is
widely patent. The external carotid artery is identified and is
otherwise normal. An angled guide wire was then advanced deep into
the external carotid artery branches and then the catheter was then
tracked into this area. Using an exchange technique over an Amplatz
wire, an 8-French JR guiding catheter was then advanced through
sheath that had been exchanged into the groin and placed with its
tip in the distal common carotid artery. With the catheter in this
position, a Spider wire embolic protection filter wire was then
advanced very carefully through internal carotid artery lesion and
placed 5 cm distal to the area of treatment. The filter wire was
deployed, and a follow-up angiogram demonstrates excellent position
without any evidence of embolism or vasospasm. After making
appropriate measurements, an Abbott Xact 6 mm × 30 mm
self-expanding stent was then deployed across the lesion under
fluoroscopy with the filter in place. The stent opened and moved
forward slightly but was otherwise in good position. With the stent
completely deployed, a 6 × 20 mm balloon was then used to post
dilate the stent to form full apposition. A follow-up angiogram was
done, which demonstrates excellent treatment of the lesion with
less than 20% residual stenosis. The filter wire is in place and
does not appear to have a severe amount of debris within it. The
filter was then retracted and removed, and a cervical carotid
angiogram demonstrated wide patency of the common internal and
external carotid arteries. The AP and lateral views of the
unilateral cerebral carotid demonstrated wide patency with
excellent flow through the MCA distribution and cross filling
without any evidence of embolism or vasospasm. The guiding catheter
and sheath were then removed with direct manual compression held
over the groin for 30 minutes. The patient was given protamine to
reverse the heparin and then loaded with Plavix, given the
placement of the stent. He maintained hemodynamic and neurological
stability throughout the entire case. The wound was then cleaned,
dried, and dressed using gauze and Tegaderm. The patient appeared
to tolerate the procedure well. There were no immediate
complications. The patient was taken to recovery room in stable
condition. A total of 70 mL of contrast was used for the entire
case