Ask Dr. Z

Hello Dr Z, I have a complex case which the physician spent an exorbitant amount of time on due to complications. My coding conflicts a great deal with what the physician wants billed, so I was hoping you could provide some insite. The procedure performed states "resection of AAA, AAA to right common iliac and left common femoral bypass using a 14x7 knitted Dacron Hemasheild graft. Left Common iliac and ext. iliac endartectomies. Reimplantation of left renal artery, reimplanation of IMA". The physician wants to code: 35540, 35351,35351-59,35697,35697-59 I coded - 35091-22 My question is: The graft did come past the iliac on the left side, but I am unable to locate a code for an extension prosethesis other than for endovascular repair. Based on this, should I code 35102 with 35697 to cover the visceral work? Also, CCI edits state 35091 and 35697 can be billed together, in what case would you do so? Any insite would be appriciated. Thank you.