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HELP with endarterectomy with patch angioplasty

  1. Default HELP with endarterectomy with patch angioplasty
    Medical Coding Books
    I am having trouble determining when to code the 35371 and 35372. I am not certain how to determine if the procedure involves a significant enough length of deep or superficial femoral arteries. Are there measures?

    This is a portion of the operative report I am reviewing.

    was performed carefully removing plaque from the vessel wall. Care was taken to inspect
    the takeoff of the profunda femoris as well as a large posterior branch preserving the
    lumen and insuring that there was no flap. The arteriotomy was extended beyond the
    profunda takeoff into the superficial femoral artery to where there was an adequate
    lumen. A decent breakpoint was obtained and the distal flap tacked with interrupted 6-0
    Prolene sutures. We then obtained a bovine patch graft and after cleansing it
    appropriately tacked it to the distal arteriotomy site and run halfway around each side
    with 6-0 Prolene. The graft was then cut appropriately and secured to the proximal
    arteriotomy site and the anastomosis completed. Prior to completing the anastomosis the
    vessel was forward bled, profunda femoris and superficial femoral artery back bled, the
    vessel suctioned out and filled with heparin saline. The anastomosis was then completed
    and the profunda femoris tape released. The common femoral artery clamp was released
    providing antegrade flow to the profunda femoris artery and subsequently the SFA clamp
    was removed. Excellent Doppler signals were noted in the SFA, profunda femoris and large
    posterior branch.

  2. #2
    Richardson, TX
    I don't believe it is based on 'length.' In my experience, if the physician documented 'deep profunda femoral' then I would bill 35372. If he speaks of the common femoral or just femoral I would not assume he did the deep femoral.

    From the dicatation you posted it appears you could bill 35372; if you don't feel comfortable go ask him/her if you are on the right track so that you know what to expect in the future and what to look for within his/her dictation.
    Julie Graham, BA, CPC, CCC

  3. Default
    Thank you!!! I appreciate your help.

  4. #4
    Central Indiana
    Lightbulb Question to ask
    The report indicates that the arteriotomy was extended into the SFA, not the PFA. There was continual disease from the CFA into the SFA, but they were only looking for a good breakpoint. 35371 is the correct code. IF there had been multiple lesions in both arteries that were being endarterectomized, then it would have been possible to bill for both. This is not the case with "one lesion" even if it crosses arterial boundaries.

    Keri H, CIRCC

  5. #5
    Albany, OR chapter
    Default Endarterectomy question
    Codes the doctor suggesting using. 35351, 35302, 35371,35372, 34812.
    The NCCI edits says that 35371 and 35372 are ok with a modifier, but the way I understand it, since the common femoral and the profunda femoral are in the same territory as the superficial femoral, shouldn't I only be coding the 35302? I was going to charge the 35351, 35302 and 34812. Thanks for any help.

    Peripheral vascular disease with right-sided stenosis of
    external iliac artery, common femoral artery and superficial
    femoral artery and profunda femoral artery and popliteal
    Peripheral vascular disease with right-sided stenosis of
    external iliac artery, common femoral artery and superficial
    femoral artery and profunda femoral artery and popliteal
    1. Exposure of right common femoral artery for endovascular
    angioplasty and stenting of distal right superficial femoral
    artery and proximal popliteal artery with postoperative
    2. Endarterectomy of right external iliac artery.
    3. Endarterectomy of right common femoral artery.
    4. Endarterectomy of right superficial femoral artery.
    5. Endarterectomy of right profunda femoral artery.

    The patient is a gentleman with significant
    intermittent claudication with CT angiogram findings
    consistent with iliofemoral stenosis and distal superficial
    femoral artery stenosis. The patient was explained his
    diagnosis, risks and complications of proposed procedure,
    alternatives, and agreed to proceed with the procedure, having
    had all his questions answered.
    The patient was taken to the operating room, placed supine on
    the operating table. After adequate IV sedation was given, the
    patient was prepped and draped in standard surgical fashion.
    SCDs applied. Preop antibiotics were given. A timeout was
    taken to confirm patient location, orientation, and procedure.
    A 7 cm incision was made in the right groin. Dissection was
    taken down to identify the common femoral artery, profunda
    femoral, superficial femoral artery. We had to extend proximal
    to get above the occlusion into the external iliac artery. We
    placed vessel loops around each vessel doubly. Dr.XX
    then assisted in performing angiograms and angioplasty and
    stenting of the right superficial femoral artery and popliteal
    artery. He will dictate that aspect of the procedure. We
    placed an 8 x 150 mm Smart stent in the distal SFA and
    popliteal artery. The patient tolerated placement well after
    this was performed with confirmation that there was no
    significant injury. Also on finding there was an occlusion at
    the trifurcation with only 2-vessel runoff and backflow into
    the anterior tibial. We then removed wires. The patient had
    been given heparin which was monitored by Dr. XX,
    anesthesiologist, with serial ACTs. We then clamped the
    superficial femoral artery, profunda femoral, and external
    iliac artery and performed an arteriotomy above the area of
    the stenosis into the external iliac artery and down into the
    superficial femoral artery. We performed a meticulous
    endarterectomy involving his external iliac artery, common
    femoral artery, superficial femoral artery, as well as
    profunda femoral artery which was open, and the plaque was
    tacked down on the profunda femoral opening. After the
    endarterectomy was completed we then closed the arteriotomy
    with a running 6-0 Pronova suture and an 8 x 80 mm bovine
    pericardium patch. There was one bleeding point which was
    oversewn. Hemostasis was obtained with Surgicel and reversal
    of the heparin. The wound was then closed with a running 3-0
    Vicryl to the deep subQ, superficial subQ interrupted 3-0
    Vicryl and running 4-0 Monocryl with Dermabond to the skin.
    The patient tolerated the procedure well. The instrument,
    needle, and swab count was reported as correct.

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