jewlz0879
True Blue
1) Are the thromboendarterectomies separately billable on the opposite side of graft placement? 35371 and 35372 have bundling edits.
2) Is the MiraQ reported with CPT 76998-26 or would it be included?
The patient was prepped and draped in sterile fashion for the above procedure from the xiphoid to the feet bilaterally. Longitudinal incisions were made in both groins. I began on the left side and then went to the right. Proximal and distal control of significant portion of the LCF artery, SFA, PF artery was obtained. The left PF artery, was dissected free for the length of about 8 to 10 cm and was the same caliber as the SFA, which was totally occluded. I did the same thing on the right over similar distances, although not as far on the right PF artery. I then tunneled a 6mm externally reinforced graft from left-to-right. Occlusion of the left femoral system was obtain and an extensive longitudinal arteriotomy from about 5cm onto the PF artery, proximal onto the CFA was performed. Extensive thromboendarterectomy of the left CFA, PF artery to its bifurcation, and proximal 2 to 3 cm of the left SFA was performed. All loose debris was removed. A longitudinal arteriotomy was close proximally to the femoral bifurcation. A long hood was created on the distal portion of the graft and an end-to-side anastomosis with the fem-fem graft was then performed with 5-0 running Prolene suture in an end-to-side fashion several centimeters on the profunda femoris encompassing the distal portion of the common femoral artery and orifice of the SFA, thud completing the profundoplasty.
It was then allowed to backbleed and flushed with heparinized saline and the graft was clamped, it was then cut to appropriate length in the right groin and a small hood was created proximally. The endarterectomies as described before were completed on the right side and loose debris was removed. A bovine pericardial patch was sewn in place from the right common femoral artery onto the SFA over the distance of about 3 cm. A graftotomy of the patch was the performed and an end-to-side anastomosis with the PTFE graft onto the bovine pericardial patch was sewn in place in an end-to-side fashion using 5-0 running prolene suture. Also of note, priot to closure of the wounds, the MiraQ Ultimate system by Medistim was used to record the flows of the right CFA proximal to the graft as well as the PF on the left showing excellent results.
Coded as:
35661 - LT
35302 - RT
35371 - XU, 50
35372 - XU, RT
76998 - 26
2) Is the MiraQ reported with CPT 76998-26 or would it be included?
The patient was prepped and draped in sterile fashion for the above procedure from the xiphoid to the feet bilaterally. Longitudinal incisions were made in both groins. I began on the left side and then went to the right. Proximal and distal control of significant portion of the LCF artery, SFA, PF artery was obtained. The left PF artery, was dissected free for the length of about 8 to 10 cm and was the same caliber as the SFA, which was totally occluded. I did the same thing on the right over similar distances, although not as far on the right PF artery. I then tunneled a 6mm externally reinforced graft from left-to-right. Occlusion of the left femoral system was obtain and an extensive longitudinal arteriotomy from about 5cm onto the PF artery, proximal onto the CFA was performed. Extensive thromboendarterectomy of the left CFA, PF artery to its bifurcation, and proximal 2 to 3 cm of the left SFA was performed. All loose debris was removed. A longitudinal arteriotomy was close proximally to the femoral bifurcation. A long hood was created on the distal portion of the graft and an end-to-side anastomosis with the fem-fem graft was then performed with 5-0 running Prolene suture in an end-to-side fashion several centimeters on the profunda femoris encompassing the distal portion of the common femoral artery and orifice of the SFA, thud completing the profundoplasty.
It was then allowed to backbleed and flushed with heparinized saline and the graft was clamped, it was then cut to appropriate length in the right groin and a small hood was created proximally. The endarterectomies as described before were completed on the right side and loose debris was removed. A bovine pericardial patch was sewn in place from the right common femoral artery onto the SFA over the distance of about 3 cm. A graftotomy of the patch was the performed and an end-to-side anastomosis with the PTFE graft onto the bovine pericardial patch was sewn in place in an end-to-side fashion using 5-0 running prolene suture. Also of note, priot to closure of the wounds, the MiraQ Ultimate system by Medistim was used to record the flows of the right CFA proximal to the graft as well as the PF on the left showing excellent results.
Coded as:
35661 - LT
35302 - RT
35371 - XU, 50
35372 - XU, RT
76998 - 26