AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2021 Issue 1; Ask the Editor
Iliofemoral Endarterectomy and Furthest Point of Entry
The patient had calcified plaque involving the entire common femoral artery, extending into bilateral distal external iliac arteries, with stenotic lesions in the profunda femoris and superficial femoral arteries. The surgeon performed bilateral iliofemoral profunda femoris endarterectomy with a patch graft. During surgery, distal dissection of the external iliac artery was carried out bilaterally. Arteriotomy was made in the common femoral artery and plaque was removed. The external iliac, proximal common femoral and profunda femoris arteries were endarterectomized, with an eversion technique to the external iliac and common femoral arteries. The arteriotomy was then extended into the superficial femoral artery, atheromatous plaque was removed and Bovine pericardial patch was fashioned. When assigning ICD-10-PCS codes, what is considered the most proximal site (i.e., the most proximal site of surgical dissection or the most proximal anatomic site of the vessel)? ...
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Article Overview
This coding article addresses a vascular surgery documentation question for ICD-10-PCS, focusing on how to interpret the operative site when multiple adjacent arteries are dissected and treated. It is relevant to inpatient coding professionals, auditors, and others assigning procedure codes for lower-extremity arterial surgery. The discussion is centered on site selection, surgical anatomy, and how the operative report should be interpreted for code assignment.
Why This Topic Matters
Accurate identification of the principal operative site is essential for consistent ICD-10-PCS procedure reporting in complex vascular cases. This article helps readers understand the scope of documentation review needed for endarterectomy cases involving more than one arterial segment.
What You Will Learn
- How the article frames a site-selection question in complex lower-extremity vascular surgery
- What operative details are relevant to ICD-10-PCS code assignment
- How bilateral arterial involvement and adjacent vessel segments are presented in the documentation context
- Why the distinction between dissection extent and anatomic vessel location matters for procedure coding
Who Should Read This
- Inpatient coders
- Coding auditors
- HIM professionals
- Clinical documentation specialists
- Vascular surgery coders
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