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Official Description

Thromboendarterectomy, including patch graft, if performed; popliteal artery

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Thromboendarterectomy is a surgical procedure specifically targeting the popliteal artery, which is the continuation of the femoral artery located behind the knee. This procedure is primarily performed to remove a thrombus, which can be a blood clot or atherosclerotic plaque that has adhered to the walls of the artery, leading to occlusion. The process involves the careful dissection of the thrombosed segment of the artery, allowing for the removal of both the thrombus and the affected vessel intima. By excising these obstructions, the procedure aims to restore normal blood flow through the artery. The surgical approach typically begins with an incision made over the knee to access the popliteal artery. Once the artery is isolated, clamps are applied to control blood flow, and an incision is made to facilitate the removal of the thrombus and plaque. The procedure may also involve the use of a patch graft, which can be harvested from the patient or sourced from a donor, or constructed from synthetic materials, to repair the artery after the obstruction has been cleared. This comprehensive approach not only addresses the immediate blockage but also aims to enhance the arterial lumen's diameter, thereby improving overall vascular health and function.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The thromboendarterectomy procedure is indicated for patients experiencing occlusion of the popliteal artery due to thrombus formation or atherosclerotic plaque. The following conditions may warrant this surgical intervention:

  • Occlusive Disease Presence of significant blockage in the popliteal artery, leading to reduced blood flow.
  • Intermittent Claudication Symptoms of pain or cramping in the leg muscles during physical activity, which is relieved by rest.
  • Critical Limb Ischemia Severe obstruction of blood flow that can lead to tissue damage or limb loss.
  • Rest Pain Pain in the feet or toes while at rest, indicating severe arterial insufficiency.

2. Procedure

The thromboendarterectomy procedure involves several critical steps to ensure the successful removal of the thrombus and restoration of blood flow. The following outlines the procedural steps:

  • Step 1: Incision An access incision is made over the knee to expose the popliteal artery. This incision allows the surgeon to gain direct access to the affected area for further dissection.
  • Step 2: Isolation and Dissection The thrombosed portion of the popliteal artery is carefully isolated from surrounding structures. This step is crucial to prevent damage to adjacent tissues during the procedure.
  • Step 3: Clamping Clamps are applied both proximally and distally to the isolated segment of the artery. This action temporarily halts blood flow, creating a controlled environment for the surgical intervention.
  • Step 4: Incision into the Vessel An incision is made into the blood vessel itself, allowing access to the thrombus and plaque. This step is essential for the removal of the obstructive materials.
  • Step 5: Removal of Thrombus and Plaque The thrombus and any adhering plaque are meticulously removed from the artery. This process may involve separating the vessel lining from the arterial walls to ensure complete excision of the obstruction.
  • Step 6: Repair with Patch Graft After the obstruction is cleared, a patch graft may be utilized to repair the artery. This graft can be harvested from the patient, obtained from a donor, or made from synthetic materials, and is sutured to the vessel to enhance its diameter and restore normal function.
  • Step 7: Closure Once the patch graft is in place, the clamps are removed, and the incision in the artery is closed. The external incision over the knee is then repaired, completing the procedure.

3. Post-Procedure

Post-procedure care following a thromboendarterectomy includes monitoring for any signs of complications, such as bleeding or infection at the incision site. Patients may be advised to rest and limit physical activity for a specified period to promote healing. Follow-up appointments are essential to assess the success of the procedure and ensure that blood flow has been adequately restored. Additionally, patients may require medication to manage any underlying conditions contributing to arterial occlusion, such as anticoagulants or antiplatelet agents, to prevent future thrombus formation.

Short Descr RECHANNELING OF ARTERY
Medium Descr TEAEC W/GRAFT POPLITEAL ARTERY
Long Descr Thromboendarterectomy, including patch graft, if performed; popliteal artery
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P1G - Major procedure - Other
MUE 1
CCS Clinical Classification 60 - Embolectomy and endarterectomy of lower limbs
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
RI Ramus intermedius coronary artery
RT Right side (used to identify procedures performed on the right side of the body)
X5 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2011-01-01 Changed Guideline information changed.
2007-01-01 Added First appearance in code book in 2007.
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