Ask Dr. Z

Patient has in-situ bypass (fem-pop). Patient also has angioplasty of the ipsilateral common, internal, and external iliacs. The common femoral was exposed, and dissection was carried down to the inguinal ligament. The LCFA was then dissected and controlled, then the physician exposed the distal popliteal and prepared for bypass. The physician then dissects the in-situ vein. He prepared the in-situ vein for bypass, then turned his attention to performing the endovascular part of the case. Through the exposed common femoral artery, a micropuncture needle is inserted…” and he performs angioplasty of the LCIA, LIIA, LEIA. He clamps the LCFA distally with clamp and proximally with clamp, then turns his attention back to the actually in-situ bypass. Can I bill out the in-situ bypass with the iliac angioplasties? I am saying NO, they can’t be billed. I need someone else’s opinion.