I'm not sure how to code this revision of a fem-pop bypass. Few weeks ago patient had the fem-pop bypass, 35656 performed and is now back with ischemic foot. Thru incision lower extremity is explored and a kink in the previous Gore-Tex graft is found. Attempts were made to pass a embolectomy catheter numerous times to reopen the above-knee popliteal graft without success and decision was made to bypass below the knee. Tunnel created from the distal proximal wound. Propaten ringed graft was anastomosed to the proximal previously placed graft at the femoral artery. The popliteal artery was exposed and the graft was anastomosed to the popliteal. Procedure concluded.

How would you code this? Would it be a revision, 35883 or would I billed the fem-pop bypass code again 35656 with a 78 modifier? Not sure where to find guidance on how to code this, so any help is appreciated.