ksschroeder
Networker
Patient undergoes an ilio-popliteal bypass with a PTFE graft. The patient's distal anastomosis was successful. Then…
“Attention was then paid to the femoral area and again proximal and distal control on the common femoral and distal external iliac was achieved and arteriotomy was made. There were areas of calcifications so the arteriotomy was extended proximally. Some old clot and calcium were endarterectomized in this area to about a 3-4 cm arteriotomy that was closed with a Hemashield patch in both directions with 6-0 Prolene suture allowing backbleeding and for award bleeding before tying the last stitch. Then our proximal anastomosis was made on top of the patch after measuring the graft appropriately. Approximately 1 cm arteriotomy was made in the patch and a proximal anastomosis was completed with running 6-0 Prolene suture again allowing backbleeding and forward bleeding before tying the last stitch.”
We feel that the thromboendarterectomy with patch graft would be included in the code for the bypass. The doctor feels it should be billed separately because it is not localized to the anastomosis area. He feels that the whole section of vessel was treated. He also feels that the work of the patch graft should be reimbursed.
Do we code with a 22 modifier added? Do we submit the thromboendarterectomy code with 59? Or do you feel we are correct to suggest billing only the bypass code?
“Attention was then paid to the femoral area and again proximal and distal control on the common femoral and distal external iliac was achieved and arteriotomy was made. There were areas of calcifications so the arteriotomy was extended proximally. Some old clot and calcium were endarterectomized in this area to about a 3-4 cm arteriotomy that was closed with a Hemashield patch in both directions with 6-0 Prolene suture allowing backbleeding and for award bleeding before tying the last stitch. Then our proximal anastomosis was made on top of the patch after measuring the graft appropriately. Approximately 1 cm arteriotomy was made in the patch and a proximal anastomosis was completed with running 6-0 Prolene suture again allowing backbleeding and forward bleeding before tying the last stitch.”
We feel that the thromboendarterectomy with patch graft would be included in the code for the bypass. The doctor feels it should be billed separately because it is not localized to the anastomosis area. He feels that the whole section of vessel was treated. He also feels that the work of the patch graft should be reimbursed.
Do we code with a 22 modifier added? Do we submit the thromboendarterectomy code with 59? Or do you feel we are correct to suggest billing only the bypass code?