Ask Dr. Z

"Patient status post heart cath with Angioseal device now intraluminal in EIA causing occlusion. Exposure of EIA then endarterectomy extended into the EIA and removal of footplate and Angioseal plug. Secondary to >50% medial wall calcified plaque, performed extended endarterectomy of EIA and CFA. Then 3 Fogarty used to perform embolectomy of profunda and SFA with multiple passes down SFA and profunda with minimal thrombus removal. Arteriotomy extended to distal CFA with focal endarterectomy with good endpoint in profunda and proximal SFA. Endpoint tacked down and arteriotomy closed with bovine pericardial patch." Would we look to CPT code 35355 (iliofemoral endarterectomy) in this case (EIA, CFA, proximal SFA, and proximal profunda)? (Embolectomy would be inclusive to the more comprehensive endarterectomy code.) For the retrieval of the Angioseal device, would this be separately billable or inclusive to the endarterectomy given the retrieval was by means of the endarterectomy? Your thoughts are greatly appreciated.