Wiki Entrapment Release

ethom1

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I need your help. Can anyone tell me the cpt code to use for popliteal artery entrapment release. I've looked and did not find anything....any suggestions?

A lazy S incision was made over the posterior thigh, knee crease and proximal calf beginning laterally in the thigh and ending medially in the calf. The subcutaneous tissue was dissection with electrocautery. Skin flaps were raised and a lone star retractor was used to aid in our exposure. The small saphenous vein was identified and suture ligated. The fascia of the superficial posterior compartment was incised and the two heads of the gastrocnemius muscle were identified. We deepened our dissection between the heads of the gastrocnemius and identified the deep fascia. This was incised vertically, and the tibial nerve and common peroneal nerve were identified. They were retracted laterally, revealing the popliteal vein deep and medial to the nerves. The popliteal vein was circumferentially dissected and encircled with a silastic vessel loop. The vein was then retracted laterally, which revealed the popliteal artery. We carefully dissected the artery as proximally as possible through our incision and as distally as possible. The take off of the ATA was identified distally and the tibioperoneal trunk. During our dissection, we identified an abnormal band of the medial head of the gastrocnemius muscle that attached to the lateral femoral condyle and was tenting the popliteal artery. This band was released using electrocautery. We also identified the soleal sling at the distal extent of our incision and released this to prevent compression and entrapment of the tibial nerve. Once we were satisfied with our muscle release, we flexed the knee and dorsiflexed the ankle. With manipulation of the leg, the popliteal artery was not noted to have any change in pulse exam or evidence of ongoing compression. We evaluated the distal pulses and the patient had palpable DP and PT at rest and with manipulation of the leg and ankle. The wound was then irrigated and closed in layers. 2-0 vicryl was used to reapproximate the superficial fascia, 3-0 vicryl was used for the deep dermis, and the skin was brought together with 4-0 monocryl. The incision was covered with dermabond and steristrips. Following wound closure, the DP and PT pulses remained palpable.
 
For the popliteal release I would use 35703.

Source: Coders' Desk Reference for Procedures by Optum
CPT 35703 Procedure description:

Through an incision in the skin overlying the targeted artery, the physician dissects around surrounding structures as necessary to access the artery, freeing it so it can be examined. The artery is released from any surrounding scar tissue that may be compressing it. Finding no perforations or other signs of injury, the physician repairs the skin incision with a layered closure. Report 35701 for exploration of arteries of the neck (e.g., carotid or subclavian); 35702 for those of the upper extremity (e.g., axillary, brachial, radial, or ulnar); and 35703 for those of the lower extremity (e.g., common, deep, or superficial femoral, peroneal, popliteal, or tibial).
 
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