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Official Description

Thromboendarterectomy, including patch graft, if performed; common femoral

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Thromboendarterectomy is a surgical procedure aimed at removing a thrombus, which can be a blood clot or atherosclerotic plaque, from the common femoral artery. This artery is a major blood vessel located in the thigh that supplies blood to the lower limb. The procedure is essential for restoring blood flow in cases where the artery has become occluded, which can lead to serious complications such as limb ischemia. During the operation, an incision is made in the leg to access the common femoral artery. The surgeon isolates the affected segment of the artery, carefully dissecting it from surrounding tissues. To maintain blood flow during the procedure, a temporary shunt may be placed. The surgeon then removes the obstructive material, including the artery's intima, which is the innermost layer of the artery wall. This removal is crucial as it helps to increase the diameter of the artery, facilitating better blood flow. After the thrombus and intima are excised, the remaining edges of the artery are sutured together, or a patch graft may be applied if necessary to further enlarge the artery. The procedure concludes with the removal of any temporary shunts, restoration of blood flow, and careful inspection of the surgical site to ensure there is no bleeding before closing the incision in layers.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The thromboendarterectomy procedure is indicated for patients experiencing significant arterial occlusion due to thrombus formation or atherosclerotic plaque in the common femoral artery. The following conditions may warrant this surgical intervention:

  • Peripheral Artery Disease (PAD) - A condition characterized by narrowed arteries reducing blood flow to the limbs, often leading to pain and mobility issues.
  • Acute Limb Ischemia - A sudden decrease in blood flow to the limb, which can result from a thrombus or embolism, causing severe pain and potential tissue damage.
  • Claudication - Pain in the legs or buttocks during physical activity due to inadequate blood flow, which may necessitate surgical intervention to improve circulation.
  • Critical Limb Ischemia - A severe form of PAD where blood flow is critically low, leading to non-healing wounds or ulcers, and increasing the risk of limb loss.

2. Procedure

The thromboendarterectomy procedure involves several critical steps to ensure the successful removal of the thrombus and restoration of blood flow. The following outlines the procedural steps:

  • Step 1: Incision - A surgical incision is made in the leg to provide access to the common femoral artery. This incision is strategically placed to allow optimal exposure of the artery for the procedure.
  • Step 2: Isolation and Dissection - The surgeon carefully isolates the thrombosed portion of the common femoral artery, dissecting it from surrounding tissues to prevent damage to adjacent structures.
  • Step 3: Temporary Shunt Placement - To maintain blood flow during the procedure, a temporary shunt may be placed across the affected area, allowing perfusion to continue while the thrombus is being removed.
  • Step 4: Clamping - Vascular clamps are applied proximal to the obstructed segment of the artery to control blood flow and create a bloodless surgical field for the removal of the thrombus.
  • Step 5: Incision of the Artery - The artery is incised to access the thrombus and plaque. The surgeon meticulously removes the obstructive material, including any blood clot debris.
  • Step 6: Intima Removal - The intima, or the inner lining of the artery, is separated from the artery walls and excised to increase the diameter of the blood vessel, facilitating improved blood flow.
  • Step 7: Repair of the Artery - The edges of the remaining normal intima are sutured to the artery walls. If necessary, a venous or synthetic patch graft is applied to enlarge the diameter of the artery further.
  • Step 8: Shunt Removal - If a temporary shunt was placed, it is removed at this stage to allow for the restoration of normal blood flow.
  • Step 9: Restoration of Blood Flow - The vascular clamps are removed, and blood flow through the artery is reinitiated, ensuring that circulation is restored.
  • Step 10: Hemostasis Check - The surgical site is inspected for hemostasis, ensuring that there is no active bleeding from the arterial suture lines.
  • Step 11: Closure - Finally, the overlying tissues are closed in layers to promote proper healing and minimize scarring.

3. Post-Procedure

After the thromboendarterectomy procedure, patients typically require monitoring for any signs of complications, such as bleeding or infection. Recovery may involve pain management and gradual mobilization to restore function in the affected limb. Follow-up appointments are essential to assess the success of the procedure and ensure that blood flow remains adequate. Patients may also be advised on lifestyle modifications and medications to prevent future thrombus formation and manage underlying conditions such as peripheral artery disease.

Short Descr RECHANNELING OF ARTERY
Medium Descr TEAEC W/WO PATCH GRAFT COMMON FEMORAL
Long Descr Thromboendarterectomy, including patch graft, if performed; common femoral
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
RT Right side (used to identify procedures performed on the right side of the body)
LT Left side (used to identify procedures performed on the left side of the body)
GC This service has been performed in part by a resident under the direction of a teaching physician
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
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).
QZ Crna service: without medical direction by a physician
X4 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
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.
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.)
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).
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.
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).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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.
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.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
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).
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).
AG Primary physician
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
HK Specialized mental health programs for high-risk populations
PD Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days
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
QJ Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b)
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
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2007-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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