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This procedure, known as thromboendarterectomy, is a surgical intervention aimed at removing a thrombus, which can be a blood clot or atherosclerotic plaque that adheres to the walls of an artery. The focus of this specific procedure is on the tibial or peroneal artery, which are critical vessels supplying blood to the lower leg. The peroneal artery, also referred to as the fibular artery, branches from the tibioperoneal trunk alongside the posterior tibial artery. Accessing these arteries typically involves making an incision approximately 2 cm posterior to the tibia. During the procedure, the surgeon divides the soleus muscle fibers that originate on the tibia to reach the posterior tibial artery, which is located in the deep posterior compartment, resting on the surface of the tibialis posterior muscle. To expose the peroneal artery, the surgeon retracts the posterior tibial vessels and continues laterally towards the flexor hallucis longus muscle, which is situated just medial to the fibula. Once the thrombosed section of the artery is identified, it is carefully isolated and dissected from surrounding structures. Clamps are then applied both proximally and distally to the affected area. An incision is made into the artery, allowing for the removal of plaque and blood clot debris. This process involves separating the vessel lining from the arterial walls, which increases the luminal diameter of the artery, thereby improving blood flow. To ensure that the artery maintains its integrity after the obstruction and vessel intima have been excised, sutures are used to secure the edges of the normal intima to the vessel walls. In some cases, a patch graft may be utilized to repair the artery; this graft can be harvested from the patient, sourced from a donor, or constructed from synthetic materials. Once the vessel is closed, the clamps are removed, and the surgical incision is subsequently repaired. It is important to code this procedure using CPT® Code 35305 for the initial tibial or peroneal artery, and CPT® Code 35306 for each additional artery treated during the same surgical session.
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The thromboendarterectomy procedure is indicated for patients presenting with occlusions in the tibial or peroneal arteries, which may be due to thrombus formation or atherosclerotic plaque buildup. The following conditions may warrant this surgical intervention:
The thromboendarterectomy procedure involves several critical steps to ensure successful removal of the thrombus and restoration of blood flow. The following outlines the procedural steps:
Post-procedure care following a thromboendarterectomy includes monitoring the patient for signs of complications such as bleeding, infection, or graft failure. Patients may require follow-up imaging studies to assess the patency of the treated artery. Pain management and rehabilitation may be necessary to aid recovery and restore normal function. The healthcare team will provide specific instructions regarding activity restrictions and wound care to ensure optimal healing and prevent complications.
| Short Descr | RECHANNELING OF ARTERY | Medium Descr | TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL | Long Descr | Thromboendarterectomy, including patch graft, if performed; tibial or peroneal artery, initial vessel | 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 |
This is a primary code that can be used with these additional add-on codes.
| 35306 | Addon Code MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Thromboendarterectomy, including patch graft, if performed; each additional tibial or peroneal artery (List separately in addition to code for primary procedure) |
| 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). | 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 | CR | Catastrophe/disaster related | 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) | RT | Right side (used to identify procedures performed on the right side of the body) | 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 |
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| 2007-01-01 | Added | First appearance in code book in 2007. |
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