# please help endarterectomy



## Kisha (Apr 15, 2013)

PROCEDURES: Right external iIliac endarterectomy, right common femoral endarterectomy,
right profundoplasty, right femoral to posterior tibial artery bypass with 6mm PTFE.

Not my area but I'm trying please help.

33762, 35351, 35372, 75620, 35500 + ? im stumped

OPERATIVE PROCEDURE: A longitudinal incision was made in the right groin down to underlying subcutaneuoos tissue. The common femoral artery circumferentially dissected free from surrounding tissue. It was severely calcified with plaque. We extended our dissection distally where the proximal superficial femoral was controlled with vessel loops. Similiarly, the dissection was continued down the profunda femoris artery. This first side branch of the profunda femoris artery to its major bifurcating branches circumferentially controlled with vessel loops. A longitudinal arteriotomy was made in the common femoral artery after the patient had been administered heparin. It was extended proximally up into the external iliac artery and distally into the profunda femoris artery down to the level of major bifurcation. Similarly, the proximal superficial femoral artery was opened long. We proceeded to remove regualr firm plaque from the external iliac artery, the common femoral artery, the proximal superficial femoral artery and the entire profunda femoris artery. Back bleeding was obtained from the profunda femoris artery major branches, irrigated with saline. Similiarly, the superficial femoral artery had brisk back bleeding. The plaque was sent to pathology. We proceeded to perform a PATCH ANGIOPLASTY of three vessels by sewing a Hemashield Finesse patch to the vessel edges using 6-0 prolene suture placed in the running fashion. Hemostasis was assured. addtl 2000 units of heparin given after passage of PTFE graft.

An incision was made over the medial aspect of the lower leg where the posterior tibial artery dissected free from surrounding tissue. Proximal and distal control obtained with vessel loops. a longitudinal arteriotomy was made in the posterior tibial artery. A 6mm ringed propaten graft was passed through a subfascial tunnel to connect the posterior tibial artery access site incision and the incision of the right groin. With adequate proximal and distal occlusion, a longitudinal arteriotomy was made over the Hemashield Patch. The ringed PTFE graft was anastomosed in an end-to-side fashion using 6-0 prolene sutures placed. We then sized and fashioned the graft to allow end-to-side anastomosis to the posterior tibial artery via suture. The patien then has a triphasic doppler signal heard over the posterior tibial artery of the lateral ankle. This doppler signal was dependent on the patency of the graft. the wounds were irrigated with saline, anastomosis obtained. subcutaneous tissue in the groin was vlosed with 2-0 vicryl sutures.


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## TWinsor (Apr 15, 2013)

are you able to post the op report.


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## Kisha (Apr 15, 2013)

*copy of report*

I have edited and posted the op report


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## TWinsor (Apr 15, 2013)

I always get confused on these also but I think;

35666 - fem/PTA bypass (using graft other than vein)
35372 - Endarterectomy 

I think the 35351 is included in the 35372.

I do know you wouldn't code the 35500 since vein was not harvested.

75620 and 33762?? not sure which other codes you meant.

Hope I helped you


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## Kisha (Apr 16, 2013)

I meant 75630 for Abd aortagram 
Thank you


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## carolhpolk (Apr 16, 2013)

*Endarterectomy/Bypass*

Look at 35355--iliofemoral endarterectomy--that would cover both of these vessels. The 35666 is correct for the bypass. Those are the only codes I see in this dictation.


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## Kisha (Apr 16, 2013)

I came up with 35351, 35666, 35371. 
35371 because it is the common (deep) artery, and 35351 external iliac, 35666 bypass


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