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Thromboendarterectomy is a surgical procedure specifically targeting the subclavian or innominate artery, which is accessed through a thoracic incision. This operation is primarily indicated for the removal of a thrombus, which can be a blood clot or atherosclerotic plaque that has formed and adhered to the inner walls of the artery, leading to occlusion. The procedure involves making an incision in the chest to gain access to the affected artery. Once accessed, the thrombus is carefully isolated and dissected from surrounding structures to prevent damage to adjacent tissues. To maintain blood flow during the procedure, a temporary shunt may be placed. The surgical team will then apply clamps to the artery both above (proximal) and below (distal) the area of obstruction. An incision is made in the artery, allowing for the removal of the thrombus and any plaque or debris that may be present. The inner lining of the artery, known as the intima, is also removed to enhance the diameter of the artery, facilitating better blood flow. After the removal of the obstructive material, the edges of the remaining healthy intima are sutured back to the arterial walls. The artery is then repaired, either through primary suturing or by using a patch graft, which can be made from venous tissue or synthetic material, to further enlarge the artery's diameter. If a shunt was utilized, it is removed at this stage, and the vascular clamps are taken off to restore blood flow through the artery. Finally, the surgical team checks the suture line for any signs of bleeding (hemostasis) before closing the overlying tissues in layers to complete the procedure.
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The thromboendarterectomy procedure is indicated for patients presenting with specific conditions affecting the subclavian or innominate artery. These indications include:
The thromboendarterectomy procedure involves several critical steps to ensure successful removal of the thrombus and restoration of blood flow. These steps include:
After the thromboendarterectomy, patients are typically monitored for any complications, including bleeding or infection at the incision site. Recovery may involve pain management and monitoring of vital signs to ensure stable blood flow. Patients may also undergo follow-up imaging studies to assess the success of the procedure and the patency of the artery. Rehabilitation may be recommended to improve circulation and restore function in the affected areas. The healthcare team will provide specific post-operative care instructions, including activity restrictions and signs of potential complications that should prompt immediate medical attention.
| Short Descr | RECHANNELING OF ARTERY | Medium Descr | TEAEC W/WO PATCH GRF SUBCLAV INNOM THORACIC INC | Long Descr | Thromboendarterectomy, including patch graft, if performed; subclavian, innominate, by thoracic incision | 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) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 61 - Other OR procedures on vessels other than head and neck |
| 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). | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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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| 2007-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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