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Vascular question!!!

  1. Default Vascular question!!!
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    Hello! I have vascular question I NEED HELP with

    A patient was brought into OR for a Thrombectomy of SFA (34201) This was done and also stents were placed (37226). Was a complex case....

    Because this whole area occluded after the stents and thrombectomy were done; he then decided to do a Fem-Pop bypass graft (35656).

    What I am questioning is would it be correct to bill the 34201 because it was the original plan. I realize that normally 34201 would be included in with the 35656, but because it was decided, after the thrombectomy, that a bypas graft was needed & am wondering if 34201-59 would be correct coding? New incisions were done for the bypass graft also~

    I am hoping someone can assit me!!

    Thanks in Advance!

  2. Default
    I am a little confused, did the vessel instantly thrombos? This was all done in the same operative session?

  3. Default
    Hello Lisammy: Yes, it was during the same session...After the physician did the thrombectomy and because of irregularity at the juncture between the previous placed (different session) stent graft and the politeal artery a 5x5 viabahn stent graft was placed at the distal thrombecomy site.

    Arteriogram surprisingly showed the stent graft to be occluded and this appeared to occur proximally and extend to the distal portion of the stent.

    This patient has lots of vascular issues. Does this help? Any assistance is sooo appreciated

    Do you do a lot of Vascular Procedure? I would love to network with someone who does..Its hard to find vascular coders..

    Thanks bunches!

  4. Default
    In that case you should be able to bill all three, with -59 on the stent and the bypass, i would lead off with the thrombectomy, even with it being lower in rvu's. I would also send op note with claim. Be prepared from them to deny the thrombectomy but you are justified in billing all three. Yes, I code for three vascular surgeons and two cardiothoracic surgeons. Email me BLANLM@CHC.NET anytime you want, it is always good to have someone to bounce ideas off.

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