Wiki help-multiple thromboendarterectomies

[cmblocher]

Please review the below report- I abstracted out that there were 3 seperate thromboendarterectomies (common femoral, Ant-TIb trunk, and the Popliteal) and one SFA thrombectomy. 35371, 35303, 35304, 34201

However- it is stating that 35371 and 34201 are bundled in 35303 & 35304. How can this be- when the common femoral artery is a seperate vessel the the ant/tib trunk and the popliteal artery. Does anyone else come across these type of cases- and how do you handle?

PREOPERATIVE DIAGNOSIS: Occluded left superficial femoral artery
(SFA), common femoral artery and popliteal artery.

OPERATIONS:
1. Right common femoral artery profundoplasty.
2. Thrombectomy and endarterectomy of the right common femoral artery.
3. Thrombectomy of the superficial femoral artery.
4. Right tibial peroneal endarterectomy with patch angioplasty.
5. Patch angioplasty of the common femoral artery.

PROCEDURE: Because her leg was acutely ischemic she was taken to the
operating room. I did a groin cutdown and got proximal distal
control of the common femoral artery. There was a heavy plaque
which had been disrupted in the common femoral artery. There was an
occlusion of the profunda as well as the superficial femoral artery
(SFA). I gave her 5,000 units of heparin, clamped proximally,
opened the artery up and did an endarterectomy. I then did a
thrombectomy from the SFA and profunda. I did not have good
backbleeding from the SFA. I therefore placed a catheter. I
performed an angiogram which showed a 90% stenosis in the stents,
approximately 10 cm distal to the ostium. There was also poor
outflow on the stents as well distally at the level of the popliteal
artery. I therefore then went down below the knee, made an incision
down below, opened the artery. I did an endarterectomy of the
popliteal and tibial peroneal trunk. I patch tacked the distal
intima and sewed a saphenous vein patch to a patch angioplasty. I
then placed a wire up across the lesion. I did balloon angioplasty
in the injured area. I then did patch angioplasty of the profunda
and common femoral artery, reestablished flow, and we had an
angiogram which showed no restriction of flow and 2-vessel runoff.
The incisions were then closed in 3 layers. We got hemostasis. The
patient had a Doppler signal in the posterior tibial at the end of
the procedure.

 

[lisammy]

All the femorals will bundle. I wish there was an add on code instead of them each having a seperate code. I was really excited when they split them up until I continuely got denials and bundles. Usually what i end up doing is billing for which vessel they do the most work on(ie which vessel they cut down on and had to repair) in this case the Common. You could also bill the Pop because it was a seperate incision with a -59.