Wiki HELP with endarterectomy with patch angioplasty

[maine4me]

I am having trouble determining when to code the 35371 and 35372. I am not certain how to determine if the procedure involves a significant enough length of deep or superficial femoral arteries. Are there measures?

This is a portion of the operative report I am reviewing.

Endarterectomy
was performed carefully removing plaque from the vessel wall. Care was taken to inspect
the takeoff of the profunda femoris as well as a large posterior branch preserving the
lumen and insuring that there was no flap. The arteriotomy was extended beyond the
profunda takeoff into the superficial femoral artery to where there was an adequate
lumen. A decent breakpoint was obtained and the distal flap tacked with interrupted 6-0
Prolene sutures. We then obtained a bovine patch graft and after cleansing it
appropriately tacked it to the distal arteriotomy site and run halfway around each side
with 6-0 Prolene. The graft was then cut appropriately and secured to the proximal
arteriotomy site and the anastomosis completed. Prior to completing the anastomosis the
vessel was forward bled, profunda femoris and superficial femoral artery back bled, the
vessel suctioned out and filled with heparin saline. The anastomosis was then completed
and the profunda femoris tape released. The common femoral artery clamp was released
providing antegrade flow to the profunda femoris artery and subsequently the SFA clamp
was removed. Excellent Doppler signals were noted in the SFA, profunda femoris and large
posterior branch.

 

[jewlz0879]

I don't believe it is based on 'length.' In my experience, if the physician documented 'deep profunda femoral' then I would bill 35372. If he speaks of the common femoral or just femoral I would not assume he did the deep femoral.

From the dicatation you posted it appears you could bill 35372; if you don't feel comfortable go ask him/her if you are on the right track so that you know what to expect in the future and what to look for within his/her dictation.

 

[maine4me]

Thank you!!! I appreciate your help.

 

[KeriH423]

Question to ask

The report indicates that the arteriotomy was extended into the SFA, not the PFA. There was continual disease from the CFA into the SFA, but they were only looking for a good breakpoint. 35371 is the correct code. IF there had been multiple lesions in both arteries that were being endarterectomized, then it would have been possible to bill for both. This is not the case with "one lesion" even if it crosses arterial boundaries.

Keri H, CIRCC