Input, please?

ksb0211

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Would this be coded as 35301 -reduced service or would there be a better code? Thanks.

PREOPERATIVE DIAGNOSIS
Critical stenosis, right internal carotid.

POSTOPERATIVE DIAGNOSIS
Totally occluded right internal carotid artery.

PROCEDURE/OPERATION
Exploration, right neck with attempted endarterectomy of right carotid artery system.

DESCRIPTION OF PROCEDURE
The patient was taken to the operating room. After induction of adequate general anesthesia, the patient was prepped with DuraPrep and draped sterilely. Perioperative antibiotics have been administered.

The initial incision was made in the right neck over the sternocleidomastoid anterior border. This was carried down to the subcutaneous tissues. The platysmal muscle was incised. The sternocleidomastoid muscle was retracted posteriorly. The common carotid artery was pulsatile and was carefully dissected and controlled proximally. Dissection was then continued distally. The facial vein was identified, doubly ligated on its lateral aspect and ligated medially with 3-0 silk suture. The ansa cervicalis was identified and traced towards its junction with the hypoglossal nerve. The patient's bulb was identified. The bulb was injected with 1.5 mL of 2% Xylocaine. The internal carotid and the external carotid were isolated and controlled with vessel loops as well as the superior thyroid branch. A stump pressure was obtained. It appeared that there was a mean arterial pressure of 65. It was felt there was adequate clamping of the common carotid artery, external carotid artery, as well as the superior thyroid branch.

With this completed, the arteriotomy was performed extended on to the internal carotid artery. There was much glomus material within the carotid itself. Actually it looks almost to be infected. Cultures were taken. The Potts scissors were utilized to extend on to the internal carotid artery. The carotid artery was known to be diminutive from the CT angiogram. It was unfortunately noted to be completely occluded and this appeared to be actually fairly chronic. This was not acute clot. The dissection was continued up well above the hypoglossal nerve and ultimately it was seen that there was no flow whatsoever in the internal carotid artery. It was then ligated. The carotid bulb was well opened. The glomus material was cleared. This was easily endarterectomized which was felt to be reasonable in this situation because of the difficulty with having ligating vasculature. Ultimately it was cleared and there was good back flow from the external carotid artery. The decision was just to close the arteriotomy and continue to allow external carotid artery flow. This was done using running 5-0 Hemashield suture. The external carotid artery was back flowed and the suture line appeared to be intact without any bleeding whatsoever. With this completed, a 7 mm Jackson-Pratt drain was placed. The wound was closed with 3-0 Vicryl to the deep tissue, then clips to the skin. The patient tolerated the procedure and was taken to the recovery room in guarded condition.
 

lisammy

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"The glomus material was cleared. This was easily endarterectomized which was felt to be reasonable in this situation because of the difficulty with having ligating vasculature. Ultimately it was cleared and there was good back flow from the external carotid artery."

This shows that an endarerectomy of the external carotid was still performed, with the same incision and closure as would be a common or internal carotid, so I feel you could bill a 35301 without any modifier for reduced service. You can ask your surgeon for sure if he doesn't agree look at 35701 exploration carotid artery with out surgical repair
 
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