# Bypass Surgeries



## Monika Liddle (Mar 13, 2009)

Hello,

I was wondering if anyone could explain how I can determine if the surgeon is performing an endaretecomy for inflow or outflow when performing a bypass graft.

Monika


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## lisigirl (Mar 13, 2009)

*Coronary endarterectomy*

I'm not sure if I am understanding the question or not but here is my answer  . If the coronary artery is so heavily diseased that the surgeon cannot find a site to bypass, then he will need to clean it out before bypassing it. The surgeon would describe opening up the vessel (more so than what is usually opened for the bypass alone) and would document removing the excessive plaque from the artery. When done removing the plaque, he would sew the bypass graft to the artery. Remember, you can only charge for performing an endarterectomy on the LAD, circumflex or RCA. All others are included in the CABG. Also remember that CPT 33572 is an add-on code.
Hope that helps.

Lisi


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## Monika Liddle (Mar 15, 2009)

Thank you for responding Lisi,

I should have been a little more specific. If my physician is performing a femoral-tibial bypass graft and also performing an endarectomy in the common femoral.

Monika


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## lisigirl (Mar 18, 2009)

Ahhh....and I don't really code these so I'm not 100%. I could have sworn I heard an endarterectomy was included in the bypass. I will check with my friend who codes for vascular surgery and let you know what she says.

Lisi

I checked with the Vascular coder here, she said the endarterectomy is included in the bypass.  If you look in the CT Surgery Coding Companion, it states under "coding tips" that establishing both inflow and outflow by any method is included."


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## whatrm01 (Mar 12, 2010)

*establishing inflow*

I have a sort of similar procedure with concerns where thrombosed femoral to popliteal bypass graft is accessed and thrombectomy performed.  In addition the patient has a aortofemoral graft that also requires a thrombectomy.  Would the rule of establishing inflow/outflow prevent billing the aortofemoral bypass thrombectomy?


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## lisammy (Mar 12, 2010)

There are some "if's" to your answer.  If the thrombectomy was performed where the the grafts meet and through the same incision then you could only bill for one thrombectomy(35875). but if there was two distinct seperate incision in the two seperate grafts then you could bill a thombectomy for each with a 59 and add in the narrative to which bypass it being operated on.
For example: cut down on proxmal fem pop graft and removed clot ,then extended incision to include distal astamosis of aort fem bpg and removed more clot----- one thrombectomy
But
Incision made into the aortfem bpg and thrombectomy was performed, pt had good flow. No flow was found in at distal end of fem pop graft so disicion was made to cut down on the fem pop bpg and a large amount of clot was removed both proxmal and distal.------two seperate thormbectomies.


hope that helps.


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