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axillary artery ligation for post op hemorrhage


Best answers
I have a tricky one i could really use help with. Pt came in thru the ED with 2 massively infected axillofemoral dacron grafts. My surgeon removed both and performed a direct repair of a ruptured axillary artery. A week later the patient started bleeding again, so he did this:

Via a new incision at the base of the neck, he located, mobilized, and controlled the subclavian artery with a vessel loop in order to eliminate a lot of the blood flow to the damaged axillary artery.
He then reopened the previous infraclavicular surgery site, ballooned and/or applied digital pressure to control the remaining bleeding vessels, and ligated the disrupted axillary artery, because he didn't think it could be repaired.
He then returned to the first incision and released the subclavian artery, verified hemostasis, then closed both incisions.

The MD wants to bill CPT 35860 and 35761 because there are 2 incisions. I'm leaning more toward 35860 alone. Would someone who is more familiar with vascular surgery please tell me if a separate code or maybe a modifier 22 is warranted here?

The axillary artery still codes to a limb vessel even though the inicisions were in the neck and chest, right? Maybe? I don't think 35761 is the right code under any circumstances.