General Surgery Coding Alert

Question: The surgeon performed a repair of a pseudoaneurysm of the right iliac artery using a bypass graft. He performed multiple thrombectomies before he was able to re-establish good blood flow. Does the bypass code include the thrombectomies or should I code them separately?

Maryland Subscriber

Answer: All of the aneurysm repair codes (which also include repair of pseudoaneurysms) also include any work the physician needs to complete to re-establish the flow of blood after the repair is made.
 
In this example, you should report 35131 (Direct repair of aneurysm, pseudoaneurysm, or excision [partial or total] and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, iliac artery [common, hypogastric, external]) for iliac artery repair, which also includes all thrombectomies or thromboendarterectomies that the procedure may require.
 
If there is good documentation that the surgeon completed significant additional work (25 percent or more), you should append modifier -22 (Unusual procedural services) to 35131. And you should submit a copy of the operative report and specifically request additional reimbursement for the procedure.