Femoral Endarterectomy

How would you code the following femoral endarterectomy. I initially thought 35371, 35372-59 (since there is a signficant portion of the profunda endarterectomized). However, another peer feels the codes should be 35372 & 35302. Any other coding experts out there have input. Thanks

POSTOPERATIVE DX:

1. Left leg ischemia, renal failure, liver disease.

2. Left femoral artery tight stenosis and a very diseased popliteal artery

and distal runoff.

3. Nonhealing ulcer at the tip of the left first toe.

PROCEDURE: Left femoral artery, deep femoral artery endarterectomy and a

primary closure.

ANESTHESIA: General.

DESCRIPTION OF PROCEDURE: The left leg was prepped and draped in regular

fashion. Plan was to do a femoral endarterectomy and if the artery was not

tightly narrowed to do bypass below in the popliteal segment which was

severely diseased and this is a patient with renal failure and diffuse

disease. After adequate time out, the incision in the left groin was made

along the course of the common femoral artery, skin and subcutaneous tissue,

fascia overlying the artery was divided. The common, deep, and superficial

femoral arteries were controlled. Multiple veins crossing the deep femoral

artery was tied and divided. A 6000 units of heparin was given to the

patient. The common femoral artery was proximally occluded. The deep femoral

artery was occluded beyond its first branch and superficial femoral artery was

controlled. Arteriotomy was made from superficial and common revealing a

nearly occlusive plaque at the distal part of the common femoral artery,

occluding the superficial femoral and markedly narrowing the deep femoral

artery. This plaque was thick, hard and this was endarterectomized from the

common to the orifice of the deep femoral to its first and second branch. The

superficial femoral artery was essentially occluded, which was approximately

endarterectomized, so we can do a good closure. After this, the artery was of

a patulous size. I closed this artery with a running suture of 6-0 Prolene.

Hemostasis was good. There was excellent flow with a Doppler. Deeper layers

were closed with 2-0

Vicryl and skin with subcuticular suture. Blood losswas about 150 mL. The

patient tolerated the procedure well and sent to the recovery room in stable

condition.

Femoral Endarterectomy