# Endarterectomy with patch Angioplasty same Vesels Angiography with Distal Bypass



## roshrom

I would sincerely appreciate if a certified IRR coder/Vascular coder could help someone very rusty on this type coding verify my code choices, please/
I cannot re-copy op note itself, but I verified with thorough op note read these procedures were done as the MD listed them here:

1. Left Lower extremity Third Order angiography                 36247-LT
2. Left Lower extremity Third Order angiography S&I           75716 LT
    ( he cannulated down to anterior tibula artery see note at bottom)

3. Bilateral upper extremity (cephalic vein harvest               +35500-50

4. Left External iliac endarterectomy                                 35351-LT
     Left Common Femoral Artery endarterectomy                 35372-LT

5. External iliac and common femoral patch angrioplasty
    with greater saphenous vein                   ( included in # 4 CPT codes)

6. Left Common Femoral to anterior tibial artery distal by-pass  35566-LT
    with reversed BILATERAL cephaclic veing

( In this procedure the MD took the two cephalic vein pieces
   and sewed them together (anatamosis) into one long graft )
_________________________________________________

Are these codes correct please?
Are the modifiers correct ?
Also:


In the body of the op note: the MD also stated I performed bilaterial iliofemoral angioplasty; I then cannulated the left external iliac artery down to the anterior tibial artery 

Would I not also code the RIGHT side he did angioplasty on, BEFORE
he went on down to the anterior tibial artery on the left?      36246-59,RT

Thanks for help based on this information alone, as long long op note too much to even put a re-dacted copy here.

Sherry


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## pblasi

CPT guidlines at the begining of section Areries and Veins states:
"Primary vascular procedure listings include establising both inflow and outflow by whatever procedures necessary.  Also included is that portion of the operative arteriogram performed by the surgeon, as indicated."

I would code the bypass and the vien harvest only.
35566
35500.LT
35500.RT
The thromboendarterectomies, unless specifically identified as separate lesions, are included in the bypass as is the arteriogram.


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## roshrom

*Reply to Endarterectomy with patch Angioplasty same Vesels Angiography with Distal By*

Thank you for this great information and correction.
I am learning these. 
Giving me CPT guidelines ( or official coding resouce) helps me find info
to study up on these.

If you have any pdf coder material on this type of coding, and have time to send, my private email is roshrom@carolina.rr.com
I do have the Interventional Radiology Coder Users Guide but did not
find endarterecomy coding discussed in that 300 page manual    

Thank you SO very much!

Sherry


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