Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > Cardiovascular Thoracic
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 10-18-2011, 01:05 PM
maine4me maine4me is offline
Guru
 
Join Date: Apr 2007
Posts: 150
maine4me is on a distinguished road
Default HELP with endarterectomy with patch angioplasty

I am having trouble determining when to code the 35371 and 35372. I am not certain how to determine if the procedure involves a significant enough length of deep or superficial femoral arteries. Are there measures?

This is a portion of the operative report I am reviewing.

Endarterectomy
was performed carefully removing plaque from the vessel wall. Care was taken to inspect
the takeoff of the profunda femoris as well as a large posterior branch preserving the
lumen and insuring that there was no flap. The arteriotomy was extended beyond the
profunda takeoff into the superficial femoral artery to where there was an adequate
lumen. A decent breakpoint was obtained and the distal flap tacked with interrupted 6-0
Prolene sutures. We then obtained a bovine patch graft and after cleansing it
appropriately tacked it to the distal arteriotomy site and run halfway around each side
with 6-0 Prolene. The graft was then cut appropriately and secured to the proximal
arteriotomy site and the anastomosis completed. Prior to completing the anastomosis the
vessel was forward bled, profunda femoris and superficial femoral artery back bled, the
vessel suctioned out and filled with heparin saline. The anastomosis was then completed
and the profunda femoris tape released. The common femoral artery clamp was released
providing antegrade flow to the profunda femoris artery and subsequently the SFA clamp
was removed. Excellent Doppler signals were noted in the SFA, profunda femoris and large
posterior branch.
Reply With Quote
  #2  
Old 10-20-2011, 10:06 AM
jewlz0879 jewlz0879 is offline
True Blue
 
Join Date: Apr 2007
Location: Richardson, TX
Posts: 779
jewlz0879 is on a distinguished road
Default

I don't believe it is based on 'length.' In my experience, if the physician documented 'deep profunda femoral' then I would bill 35372. If he speaks of the common femoral or just femoral I would not assume he did the deep femoral.

From the dicatation you posted it appears you could bill 35372; if you don't feel comfortable go ask him/her if you are on the right track so that you know what to expect in the future and what to look for within his/her dictation.
__________________
Julie Graham, BA, CPC
Reply With Quote
  #3  
Old 10-20-2011, 10:55 AM
maine4me maine4me is offline
Guru
 
Join Date: Apr 2007
Posts: 150
maine4me is on a distinguished road
Default

Thank you!!! I appreciate your help.
Reply With Quote
  #4  
Old 11-03-2011, 09:06 PM
KeriH423 KeriH423 is offline
Networker
 
Join Date: Apr 2007
Location: Central Indiana
Posts: 52
KeriH423 is on a distinguished road
Lightbulb Question to ask

The report indicates that the arteriotomy was extended into the SFA, not the PFA. There was continual disease from the CFA into the SFA, but they were only looking for a good breakpoint. 35371 is the correct code. IF there had been multiple lesions in both arteries that were being endarterectomized, then it would have been possible to bill for both. This is not the case with "one lesion" even if it crosses arterial boundaries.

Keri H, CIRCC
__________________
KeriH423
Reply With Quote
  #5  
Old 02-24-2014, 02:07 PM
jan goar jan goar is offline
Contributor
 
Join Date: Apr 2007
Location: Albany, OR chapter
Posts: 10
jan goar is on a distinguished road
Default Endarterectomy question

Codes the doctor suggesting using. 35351, 35302, 35371,35372, 34812.
The NCCI edits says that 35371 and 35372 are ok with a modifier, but the way I understand it, since the common femoral and the profunda femoral are in the same territory as the superficial femoral, shouldn't I only be coding the 35302? I was going to charge the 35351, 35302 and 34812. Thanks for any help.



PREOPERATIVE DIAGNOSIS:
Peripheral vascular disease with right-sided stenosis of
external iliac artery, common femoral artery and superficial
femoral artery and profunda femoral artery and popliteal
artery.
POSTOPERATIVE DIAGNOSIS:
Peripheral vascular disease with right-sided stenosis of
external iliac artery, common femoral artery and superficial
femoral artery and profunda femoral artery and popliteal
artery.
PROCEDURE PERFORMED:
1. Exposure of right common femoral artery for endovascular
angioplasty and stenting of distal right superficial femoral
artery and proximal popliteal artery with postoperative
angiograms.
2. Endarterectomy of right external iliac artery.
3. Endarterectomy of right common femoral artery.
4. Endarterectomy of right superficial femoral artery.
5. Endarterectomy of right profunda femoral artery.

INDICATION FOR PROCEDURE:
The patient is a gentleman with significant
intermittent claudication with CT angiogram findings
consistent with iliofemoral stenosis and distal superficial
femoral artery stenosis. The patient was explained his
diagnosis, risks and complications of proposed procedure,
alternatives, and agreed to proceed with the procedure, having
had all his questions answered.
DESCRIPTION OF PROCEDURE:
The patient was taken to the operating room, placed supine on
the operating table. After adequate IV sedation was given, the
patient was prepped and draped in standard surgical fashion.
SCDs applied. Preop antibiotics were given. A timeout was
taken to confirm patient location, orientation, and procedure.
A 7 cm incision was made in the right groin. Dissection was
taken down to identify the common femoral artery, profunda
femoral, superficial femoral artery. We had to extend proximal
to get above the occlusion into the external iliac artery. We
placed vessel loops around each vessel doubly. Dr.XX
then assisted in performing angiograms and angioplasty and
stenting of the right superficial femoral artery and popliteal
artery. He will dictate that aspect of the procedure. We
placed an 8 x 150 mm Smart stent in the distal SFA and
popliteal artery. The patient tolerated placement well after
this was performed with confirmation that there was no
significant injury. Also on finding there was an occlusion at
the trifurcation with only 2-vessel runoff and backflow into
the anterior tibial. We then removed wires. The patient had
been given heparin which was monitored by Dr. XX,
anesthesiologist, with serial ACTs. We then clamped the
superficial femoral artery, profunda femoral, and external
iliac artery and performed an arteriotomy above the area of
the stenosis into the external iliac artery and down into the
superficial femoral artery. We performed a meticulous
endarterectomy involving his external iliac artery, common
femoral artery, superficial femoral artery, as well as
profunda femoral artery which was open, and the plaque was
tacked down on the profunda femoral opening. After the
endarterectomy was completed we then closed the arteriotomy
with a running 6-0 Pronova suture and an 8 x 80 mm bovine
pericardium patch. There was one bleeding point which was
oversewn. Hemostasis was obtained with Surgicel and reversal
of the heparin. The wound was then closed with a running 3-0
Vicryl to the deep subQ, superficial subQ interrupted 3-0
Vicryl and running 4-0 Monocryl with Dermabond to the skin.
The patient tolerated the procedure well. The instrument,
needle, and swab count was reported as correct.
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 12:24 PM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC