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Would you code only the embolectomy or both the embo and endarterectomy?
34201…35372

Thanks!

OPERATION PERFORMED:
1.  Right femoral thromboembolectomy.
2.  Right common femoral and profunda femoris endarterectomy.

ANESTHESIA:  General endotracheal anesthesia.

ESTIMATED BLOOD LOSS:  150 mL.

COMPLICATIONS:  None apparent.

SPECIMENS:  None.

FINDINGS:  Thrombosed right aortobifemoral bypass graft limb with outflow stenosis in the superficial femoral artery and profunda femoris artery.

INDICATIONS:  This 61-year-old male had undergone an aortobifemoral bypass graft with Dacron back in 2006 by Dr. David Han.  The patient was seen in followup for suture removal, however, did not return for any surveillance scanning beyond October of 2006.  For the last several months, he has been noticing claudication at a short distance in his right thigh and hip, however, this became suddenly worse, waking him out of asleep at approximately 11 p.m. last evening.  He presented to Harrisburg Emergency Room last night approximately 1 a.m. and was transferred here, anticoagulated, motor intact with mild sensory deficits.  At that time, I evaluated in emergency room.  His cap refill had improved, however, still sluggish and no Doppler signals are obtainable on the right foot.  Emergent operation was recommended for thrombectomy and possible angiography.  He understood the risks and benefits and wished to proceed.

OPERATION:  The patient was brought to the hybrid operating room and placed in a supine position.  After adequate general endotracheal anesthesia was achieved and time-out performed, leads placed, the groin and right leg were prepped and draped in a sterile fashion.  A longitudinal incision was made over the previous incision and carried down through the soft tissues.  The limb of the bypass graft was then encountered and dissected free from the surrounding structures.  The femoral bifurcation was dissected free from surrounding structures as was the superficial femoral artery and the profunda femoris.  These vessels felt soft approximately 1 cm beyond their origin; however, there was a firm calcific plaque appreciated at the origin of the superficial femoral artery.  The profunda had a posterior takeoff noted externally.  The patient was systemically heparinized with 5000 units of IV heparin.  After 3 minutes, the aortobifemoral limb was clamped with a Fogarty Hydragrip and the profunda femoris and superficial femoral artery secured with vessel loops.  A longitudinal atriotomy was created and fresh thrombus encountered.  A #5 embolectomy catheter was passed proximally with retrieval of a marked amount of thrombus as well as the meniscus with excellent inflow.  There was granular atheroma noted at the orifice of the profunda femoris artery which had a posterior takeoff and significant granular atheroma and plaque noted at the origin of the superficial femoral artery.  These were gently teased away and endarterectomy performed.  The #4 Fogarty embolectomy catheter was passed approximately 20 cm into the superficial femoral artery with no retrieval clot and vigorous back bleeding.  At this point, once the endarterectomy was completed, a bovine pericardial patch was then used to close the longitudinal arteriotomy.  Prior to completion of the anastomosis, antegrade and retrograde flushing was performed with excellent flow.  The anastomosis was secured and appeared to be hemostatic.  The Doppler signals were present in the profunda femoris artery as well as the dorsalis pedis and posterior tibial arteries.  The incision was inspected for hemostasis and when this was achieved, the wound was closed in layers with running 3-0 Vicryl suture followed by interrupted 4-0 vertical mattress of nylon and a sterile dressing.  The patient awakened from anesthesia and appeared to tolerate the procedure well without immediate complication.  Sponge, needle, and instrument counts reported as correct at the end of the case.  I was present for the entire portion of procedure.