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)?
Assign the following ICD-10-PCS code:
In procedures on the vascular system where a single procedure spans more than one body part as defined by the ICD-10-PCS body part value, the body part value assigned is the anatomically most proximal (closest to the heart) vessel operated on regardless of the access site/point of entry used to get to that vessel.
The documentation states that calcified atheromatous plaque involved multiple body parts, and the dissection commenced at the external iliac artery and completed at the superficial femoral artery. Therefore, the external iliac artery is the most proximal anatomical vessel treated and the appropriate body part.