Ask Dr. Z

I've had two denials from insurance stating procedure was not confirmed in the medical record. The physician stated an iliofemoral endarterectomy was performed and then went on to detail it. The questions are how high into the iliac do you have to go in order to consider the procedure an iliofemoral endarterectomy? Do you need to make arteriotomy in the iliac to report code 35355? The procedure was described as follows: "Incision was made over the common femoral artery in a longitudinal fashion. Dissection was deepened, and the common femoral, superficial femoral, and profunda femoral were carefully dissected free. Because of the extensive plaquing dissection was extended proximally, and the external iliac was encircled with a vessel loop on each side. Patient was given 5000 units heparin. External iliac, profunda, and SFA were clamped and longitudinal incision made in common femoral artery and carried proximally and distally onto the SFA. Careful and complete endarterectomy was performed with excellent endpoints being achieved in external iliac, proximal profunda, and proximal SFA."