Ask Dr. Z

Hi, Dr. Z: Our surgeon has been using some atherectomy devices that can also retrieve thrombus. He is dictating thromboembolectomy and then also angioplasty on the same case. We are not sure if we should be coding these as an atherectomy or thrombectomy. here is an example:Procedure: thromboembolectomy of the RT popliteal extending into the tibial peroneal trunk and into the peroneal artery; angioplasty of RT popliteal artery extending into the tibial peroneal trunk and also peroneal artery; angioplasty of RT popliteal artery; angiplasty of RT SFA. From the Description: A mini Pathway device was introduced over the gguidewire and multiple passes were made throught the complete occlusion of the distal popliteal artery extending into the tibial peroneal trunk and then into the peroneal artery. Post thromboembolectomy revealed residual stenosis greater that 50%. Thus a 2.5 mm x 150 mm angiplasty balloon was introduced over the guidewire, and angiplasty at the level of the distal right popliteal artery extending into the tibial peroneal trunk and into the peroneal artery was carried out. post angioplasty revealed significantly improved results. Catheter removed. A 5mm x 150 mm angiplasty balloon was then introduced over the guidewire and angioplasty of the right popliteal artery was carried out. Due to heavy calcification, the angioplasty of the distal right superficial femoral artery was carried out. Would you code the procedures: 35495, 35474x 2 or 37186, 35474 x 2? Thank you so much for your help!