# Help with coding procedure



## pygreen (Dec 2, 2009)

Please help I am fairly new to Vascular.  I know the exploration cannot be coded.   I was looking at CPT code 35303.

OP NOTE

PreOp/Post OP Diagnosis:  Occlusion of left popliteal artery

Procedures:  Reconstructions of the left popliteal artery below the knee
                  Thrombectomy of the left popliteal artery
                  Left popliteal exploration

After proper consent and permit secured on the chart, patient was brought to the operating room.  Patient's left lower extremity was prepped and drapped in standard sterile fashion.  The patient's consent was checked against that on the chart and agreed upon by all in the room. The patient recieved appropriate preoperative antibiotics prior to skin incision.  An infrapopliteal, below the knee exploration was undertaken and the tendinous attachments of the fastroc were subsequently dissected free.  The popliteal artery was freed proximally and distally and controlled with vessel loops.

After arterial bed were isolated, the patient was given units of heparin.  After 5 minutes, an arteriotomy in the part was then made.  A thrombectomy was then performed of the popliteal artery.  Large amounts of embolic debris were then removed from the popliteal artery proximally and distally.  This was sent for specimen.  Of note, the popliteal was diffusely diseased and therefore, it was decided by the dictating physician after examination of the arterial wall, that a reconstruction of the popliteal artery would be undertaken.  Therefore the artery was transected and reanastomosed together with 6-0 Prolene using a Bovine vessel prosthetic.  Flow was re-established into the popliteal artery and a triphasic wave form was present above and below the bypass.  Of note, also the left dorsalis pedis pulse was present at the completion of this anastomosis.

The left below knee popliteal exploration was then washed out and closed with a series of Vicryls as well as staples for the skin.  Dry dressing was then applied.

Thanks for any help on this.


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## mikereyland (Dec 2, 2009)

I would use 34203 fot the thrombectomy since the surgeon did not say it was a thromboendarterectomy.
As for the transection and reanastomoses I would think 37799 (Unlisted Procedure) or maybe 35286-59.

Michael D. Reyland, CPC, CIRCC
Surgical Specialist of Georgia


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## pygreen (Dec 2, 2009)

Thank you for your quick response.


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