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A reoperation for carotid thromboendarterectomy is a surgical procedure performed on the carotid artery more than one month after the initial operation. This intervention is necessary when there is a recurrence of occlusion due to thrombus formation, which may include blood clots or atherosclerotic plaque that has re-adhered to the arterial walls. The procedure aims to restore normal blood flow by removing these obstructions and the inner lining of the artery, known as the intima, which can become thickened or damaged. The surgery involves making an incision in the neck to access the carotid artery, isolating the affected segment, and carefully dissecting it from surrounding tissues. To ensure that blood flow to the brain is maintained during the operation, a temporary shunt may be placed. The surgical team will then clamp the artery above and below the blockage, incise the artery, and meticulously remove the plaque and clot debris. Following this, the intima is separated from the arterial wall and excised to enhance the artery's diameter. The remaining healthy intima is sutured back to the vessel walls, and the artery is reconstructed either with sutures alone or with a patch graft made from either venous tissue or synthetic material to further enlarge the artery's diameter. After the procedure, if a shunt was used, it is removed, and blood flow is restored by releasing the clamps. The surgical site is then checked for any bleeding before the layers of tissue are closed. This detailed approach ensures that the carotid artery is effectively cleared of obstructions, thereby reducing the risk of stroke and improving cerebral perfusion.
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The reoperation for carotid thromboendarterectomy is indicated in specific clinical scenarios where there is a need to address recurrent occlusion of the carotid artery. The following conditions may warrant this procedure:
The reoperation for carotid thromboendarterectomy involves several critical procedural steps to ensure the effective removal of occlusions and restoration of blood flow. The following steps outline the procedure:
After the reoperation for carotid thromboendarterectomy, patients are typically monitored for any complications, including bleeding or infection at the surgical site. Recovery may involve a hospital stay for observation, during which vital signs and neurological status are closely assessed. Patients may be advised on activity restrictions and follow-up appointments to monitor the success of the procedure and ensure proper healing. Additionally, medication may be prescribed to manage any underlying conditions, such as anticoagulants to prevent future thrombus formation. The overall goal of post-procedure care is to ensure a safe recovery and to minimize the risk of further cerebrovascular events.
| Short Descr | REOPERATION CAROTID ADD-ON | Medium Descr | ROPRTJ CRTD TEAEC > 1 MO AFTER ORIGINAL OPRATIO | Long Descr | Reoperation, carotid, thromboendarterectomy, more than 1 month after original operation (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) | P2C - Major Procedure, cardiovascular-Thromboendarterectomy | MUE | 1 | CCS Clinical Classification | 51 - Endarterectomy, vessel of head and neck |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 35301 | MPFS Status: Active Code APC C Physician Quality Reporting PUB 100 CPT Assistant Article Illustration for Code Thromboendarterectomy, including patch graft, if performed; carotid, vertebral, subclavian, by neck incision |
| 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. | 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). | 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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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2010-01-01 | Changed | Code description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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