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Thromboendarterectomy is a surgical procedure aimed at removing a thrombus, which can be a blood clot or atherosclerotic plaque, from the abdominal aorta or other major arteries such as the mesenteric, celiac, or renal arteries. This procedure is essential for restoring blood flow in cases where these arteries have become occluded due to the buildup of plaque or clots that adhere to the vessel walls. The process begins with an incision in the abdomen to access the affected blood vessel. Once exposed, the thrombosed section is carefully isolated and dissected from surrounding tissues. To maintain blood flow during the procedure, a temporary shunt may be placed. Vascular clamps are then applied both proximal and distal to the obstruction, allowing the surgeon to incise the artery and remove the thrombus along with the intima, which is the inner lining of the artery. This removal increases the diameter of the vessel, facilitating better blood flow. After the thrombus and intima are excised, the remaining edges of the normal intima are sutured back to the artery walls. The artery is then repaired, either through primary suturing or by using a patch graft, which can be made from venous or synthetic material to further enlarge the vessel's diameter. Once the repair is complete, any temporary shunts are removed, clamps are released to restore blood flow, and the surgical site is closed in layers to ensure proper healing.
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The thromboendarterectomy procedure is indicated for patients experiencing significant arterial occlusion due to thrombus formation or atherosclerotic plaque. The specific conditions that may warrant this procedure include:
The thromboendarterectomy procedure involves several critical steps to ensure successful removal of the thrombus and restoration of blood flow. The steps are as follows:
After the thromboendarterectomy procedure, patients are typically monitored for any complications, including bleeding or infection. Recovery may involve a hospital stay where vital signs are closely observed. Patients may be advised on activity restrictions and follow-up appointments to assess the success of the procedure and ensure proper healing. Pain management and wound care instructions will also be provided to facilitate recovery. It is essential for patients to adhere to any prescribed medications, such as anticoagulants, to prevent future thrombus formation and to maintain regular follow-up with their healthcare provider for ongoing assessment of vascular health.
| Short Descr | RECHANNELING OF ARTERY | Medium Descr | TEAEC W/WO PATCH GRAFT ABDOMINAL AORTA | Long Descr | Thromboendarterectomy, including patch graft, if performed; abdominal aorta | 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). | 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 | GW | Service not related to the hospice patient's terminal condition | 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 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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