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Official Description

Thromboendarterectomy, including patch graft, if performed; iliofemoral

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Thromboendarterectomy is a surgical procedure specifically targeting the iliac or iliofemoral arteries, which are critical blood vessels supplying blood to the lower extremities. This procedure is primarily indicated for the removal of thrombi, which are blood clots, or atherosclerotic plaques that have formed on the inner walls of these arteries, leading to occlusion and impaired blood flow. The procedure involves making an incision in the abdomen to access the iliac artery, and in cases involving the iliofemoral artery, an additional incision in the leg is necessary to adequately expose the affected area. During the operation, the surgeon isolates the thrombosed segment of the artery, carefully dissecting it from surrounding tissues. To ensure continuous blood flow during the procedure, a temporary shunt may be placed. The surgical technique includes clamping the artery above and below the blockage, incising the artery, and meticulously removing the thrombus and any plaque. The intima, which is the innermost layer of the artery, is also removed to enhance the artery's diameter, facilitating improved blood flow. The procedure concludes with the suturing of the artery, either primarily or with the use of a patch graft, followed by the removal of the shunt and clamps, and ensuring hemostasis before closing the incision layers. This comprehensive approach aims to restore normal blood circulation and alleviate symptoms associated with arterial occlusion.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

Thromboendarterectomy is indicated for patients presenting with specific conditions that lead to occlusion of the iliac or iliofemoral arteries. The following are the primary indications for this procedure:

  • Occlusive Arterial Disease Patients with significant occlusion due to thrombus or atherosclerotic plaque formation in the iliac or iliofemoral arteries, resulting in reduced blood flow to the lower extremities.
  • Intermittent Claudication Individuals experiencing pain or cramping in the legs during physical activity, which is relieved by rest, indicating compromised blood supply.
  • Critical Limb Ischemia Patients with severe arterial blockage leading to rest pain, non-healing wounds, or ulcers in the lower extremities, necessitating surgical intervention to restore blood flow.

2. Procedure

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:

  • Step 1: Incision An access incision is made in the abdomen to reach the iliac artery. For the iliofemoral artery, an additional incision is made in the leg to provide adequate exposure of the affected area.
  • Step 2: Isolation and Dissection The thrombosed portion of the artery is carefully isolated and dissected from adjacent structures to prevent damage to surrounding tissues during the procedure.
  • Step 3: Temporary Shunt Placement To maintain perfusion and blood flow during the surgery, a temporary shunt may be placed across the artery.
  • Step 4: Clamping Vascular clamps are applied both proximal and distal to the obstructed segment of the artery to control blood flow and create a working field.
  • Step 5: Artery Incision The artery is incised, allowing access to the thrombus and plaque that need to be removed.
  • Step 6: Removal of Thrombus and Plaque The thrombus and any atherosclerotic plaque debris are meticulously removed from the artery to clear the blockage.
  • Step 7: Intima Removal The artery lining, known as the intima, is separated from the artery walls and excised to increase the diameter of the artery, facilitating improved blood flow.
  • Step 8: Artery Repair The edges of the remaining normal intima are sutured to the artery walls. The artery is then repaired primarily with sutures, or a venous or synthetic patch graft is applied to enlarge the diameter of the artery.
  • Step 9: Shunt Removal If a temporary shunt was placed, it is removed at this stage of the procedure.
  • Step 10: Restoration of Blood Flow The vascular clamps are removed, allowing blood flow to be reinitiated through the artery.
  • Step 11: Hemostasis Check The arterial suture line is carefully checked for hemostasis to ensure there is no bleeding at the surgical site.
  • Step 12: Closure Finally, the overlying tissues are closed in layers to complete the procedure.

3. Post-Procedure

After the thromboendarterectomy, patients typically require monitoring for any complications, including bleeding or infection at the incision sites. Recovery may involve pain management and gradual mobilization to restore normal function. Follow-up appointments are essential to assess the success of the procedure and ensure that blood flow has been adequately restored. Patients may also need to adhere to a prescribed regimen of medications to manage any underlying conditions, such as anticoagulants or antiplatelet agents, to prevent future thrombus formation. The healthcare team will provide specific instructions regarding activity levels, wound care, and any necessary lifestyle modifications to support recovery and overall vascular health.

Short Descr RECHANNELING OF ARTERY
Medium Descr TEAEC W/WO PATCH GRAFT ILIOFEMORAL
Long Descr Thromboendarterectomy, including patch graft, if performed; iliofemoral
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 60 - Embolectomy and endarterectomy of lower limbs
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)
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).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
GC This service has been performed in part by a resident under the direction of a teaching physician
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).
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.)
81 Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number.
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).
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
CR Catastrophe/disaster related
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
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
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
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
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2007-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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