Ask Dr. Z

My physician did an aorto-bi-femoral bypass with aortic thromboendarterectomy, left common femoral endarterectomy with eversion endarterectomy of the profunda femoris, and endarterectomy of the proximal superficial femoral with tacking of the intima of the SFA and patch angioplasty of the CFA and SFA. It is my understanding that the thromboendarterectomy (both aortic and femoral) would be included in the bypass coding. He disagrees and says he does more work than just establishing inflow/outflow. Also, he wants to code for the profunda and superficial endarterectomy in addition to the CFA endarterectomy. I was under the impression that if it was one arteriotomy and one patch angioplasty you would use only one code (CFA, 35371). From what I can tell from his op note, only one arteriotomy was made and one patch angioplasty used. I guess my question is, when would it be appropriate to code separately for the endarterectomy with bypass and when would it be appropriate to code for more than just the CFA endarterectomy when the profunda and SFA are done as well?