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The procedure described by CPT® Code 35306 is a thromboendarterectomy, which is a surgical intervention aimed at removing a thrombus, or blood clot, as well as atherosclerotic plaque that may be adhering to the walls of an occluded artery. This procedure specifically targets the tibial or peroneal arteries, which are critical for 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. Access to these arteries is typically achieved through a surgical incision located approximately 2 cm posterior to the tibia. During the procedure, the surgeon divides the soleus muscle fibers that originate on the tibia to gain access to the posterior tibial artery, which is situated 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 located just medial to the fibula. Once the thrombosed section of the artery is isolated, clamps are applied both proximally and distally to the area of interest. An incision is then made into the blood vessel, allowing for the removal of plaque and any blood clot debris. The procedure 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 edges of the normal intima remain securely attached to the vessel walls after the obstruction has been removed, sutures are placed. In some cases, a patch graft may be utilized to repair the artery; this graft can be harvested from the patient or obtained from a donor, or it may be made from synthetic materials. Once the vessel is closed, the clamps are removed, and the surgical incision is repaired. It is important to note that CPT® Code 35306 is used to report each additional tibial or peroneal artery treated during the procedure, following the initial artery, which is reported with CPT® Code 35305.
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The thromboendarterectomy procedure, as described by CPT® Code 35306, is indicated for patients presenting with occlusion of the tibial or peroneal arteries due to thrombus formation or atherosclerotic plaque. 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 procedural steps are outlined:
Following the thromboendarterectomy, patients typically require monitoring for any complications, such as bleeding or infection at the surgical site. Recovery may involve pain management and gradual mobilization to restore function in the affected limb. Patients may also need follow-up appointments to assess the success of the procedure and ensure that blood flow has been adequately restored. The healthcare team will provide specific post-operative care instructions, including activity restrictions and signs of potential complications that should be reported immediately.
| Short Descr | RECHANNELING OF ARTERY | Medium Descr | TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART | Long Descr | Thromboendarterectomy, including patch graft, if performed; each additional tibial or peroneal artery (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | 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 | 2 | CCS Clinical Classification | 60 - Embolectomy and endarterectomy of lower limbs |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 35305 | MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Thromboendarterectomy, including patch graft, if performed; tibial or peroneal artery, initial vessel |
| 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. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure 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) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2011-01-01 | Changed | Guideline information changed. |
| 2007-01-01 | Added | First appearance in code book in 2007. |
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