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Resection carotid artery tumor with eversion carotid endarterectomy

Date: Dec 28, 2022


"Patient presents with right carotid body tumor for resection. During dissection it was found that the vascular pedicle was densely adherent to the carotid bifurcation. While dissecting this free, the lumen of the bifurcation was entered. The vascular pedicle was isolated, ligated, and transected. The remainder of the tumor was dissected free from both ICA and ECA and posterior attachments and sent to pathology. The laceration to the carotid bulb and proximal ICA could not be readily accessed, therefore the right ICA was transected, eversion endarterectomy performed, distal end-point tacked, and re-anastomosed in bidirectional running fashion. Completion duplex was performed, and wound was closed. Findings: Right carotid body tumor 4x5x3.5 cm resected. This required eversion endarterectomy, as tumor was densely adherent to the carotid bifurcation." 

Are we able to bill for the endarterectomy (35301) in addition to the tumor resection (60600), or would this be considered inherent to the primary procedure given its (iatrogenic) nature and repair during the same operative session?

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