Reporting and Coding Femoral Popliteal Bypass Surgery

Reporting and Coding Femoral Popliteal Bypass Surgery Femoral popliteal bypass surgery is used to treat femoral artery disease. Here is a detailed look at the procedure along with related CPT and ICD-10 codes.

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Femoral popliteal bypass surgery is a procedure to treat severe blockage due to the formation of plaque in the femoral artery. Also called femoropopliteal or Fem-Pop bypass surgery, this surgical procedure is performed to bypass the blocked portion of the main artery in the leg using a piece of another blood vessel. The femoral and popliteal arteries are located in the legs. Being the largest artery in the thigh, its function is to supply oxygen-rich blood and nutrients to the legs. Generally, femoral and popliteal arteries are called peripheral arteries because of their location away from the center of the body. The disease of the arteries of the limbs (especially the legs and feet) is referred to as peripheral arterial disease (PAD). Blockage mainly occurs due to plaque buildup or atherosclerosis. Atherosclerosis in the leg arteries causes peripheral vascular disease. The same process causes heart disease and stroke as well.

Reporting vascular diagnoses, treatment and coding can be complex, with the increasing body of regulations. Medical coding outsourcing helps healthcare providers ensure accurate reporting of services rendered for appropriate reimbursement.

Femoral popliteal surgery is used to treat conditions that affect circulation which include – Claudication and Peripheral vascular disease (PVD)/peripheral arterial disease (PAD).

Claudication refers to limping due to chronic pain in the thigh, calf, and/or buttocks that occurs when walking. Claudication may be a symptom of peripheral arterial disease (PAD). PVD on the other hand, occurs when the narrowed blood vessels outside the heart cannot supply enough oxygen and nutrients to the body. If left untreated, PVD can cause chronic wounds on the limbs and increase the risk of heart attack or stroke.

Why Is Femoral Popliteal Bypass Done?

Surgeons generally conduct this procedure to treat different types of problems, including  Non-healing wounds or ulcer  Infection or gangrene

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 Claudication or pain while at rest  Danger of loss of limb due to decreased blood flow  Ischemic rest pain (lack of oxygen and nutrients to the leg resulting in pain at rest)  Cold feet to touch  Pain in the legs while lying flat and relieved by a sitting position  Loss of pulse in legs or feet In most cases, other therapies such as medications, physical exercises, and wound care are opted initially. However, if these fail and alternative treatments such as a balloon angioplasty and stenting are not suitable, then tests may be performed to assess the possibilities of a surgical bypass.

Some complications that accompany femoral popliteal bypass are – wound infection, heart attack (heart arrhythmia), irregular heartbeats, blood clots, swelling in the legs, nerve injury, re-stenosis, fluid in the lungs, bleeding (where the catheter is put in after the procedure) and blockage in the graft used in bypass surgery.

Femoral Popliteal Bypass – the Procedure To bypass the narrowed or blocked blood vessel, blood is redirected through either a healthy blood vessel that has been transplanted or a man-made graft material. This vessel is sewn above and below the diseased artery so that blood flows through the new vessel or graft. In most cases, the surgeon will determine what type of material is best suited to bypass the blood vessel. Before undergoing the Fem-Pop bypass surgery, patients will be given a mild sedative through the IV line in their arm or collarbone area. More catheters may also be put in their neck and wrist to correctly monitor heart and blood pressure, and to get blood samples. The surgeon will mark the surgical area with a special pen. If there is too much hair at the surgical site, it may be shaved off.

A femoral popliteal bypass may be done either under a general or an epidural/spinal anesthesia. The anesthesiologist will continuously monitor the patient’s heart rate, blood

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pressure, breathing, and blood oxygen level during the surgery. The surgeon will make incisions in the leg. The site of the incision will mainly depend on the section of the arteries to be bypassed. The physician will determine whether to use a prosthetic graft or a vein from the leg to bypass the diseased artery.

As part of the bypass surgery, a cut is made is made in the groin to expose the femoral artery (which is the main artery and is usually the point from which the bypass starts). A second incision will be made just above or below the knee and is on the inner side of the leg. This is done to expose the artery below the blockage. In most cases, the incisions will be lower in the calf and may be there on either side.

The tube used to perform the bypass will normally be the patient’s own repositioned vein of the leg. Often called the long saphenous vein - it runs up the inner side of the leg from ankle to groin. If this vein is not long enough or lacks sufficient quality, then the same vein from the other leg or a vein from the arms can be used. However, if no vein is suitable, an artificial tube will be used and this tube will be adjoined to the artery at groin level and again to the artery below the blockage with very fine permanent stitches. At the end of the operation, all the incisions are closed either with dissolving stitches or nondissolving stitch or metal clips which will normally be removed after about 7-10 days.

Vascular medical coding can be complex. Vascular surgeons or other specialists performing femoral popliteal bypass procedures must use the relevant diagnosis and procedure codes to bill the procedure correctly. The following codes are used for medical billing purposes – CPT Codes  35556 - Femoral to popliteal bypass with vein  35566 - Femoral to tibial vessel bypass with vein  35571 - Popliteal to tibial vessel bypass with vein  35583 - Femoral to popliteal in situ

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 35585 - Femoral to tibial vessel in situ  35587 - Popliteal to tibial vessel in situ  35656 - Femoral to popliteal with prosthetic  35666 - Femoral to tibial vessel with prosthetic  35671 - Popliteal to tibial vessel with prosthetic ICD-10 Codes  041M3JQ - Bypass Right Popliteal Artery to Lower Extremity Artery with Synthetic Substitute, Percutaneous Approach  041M3JS - Bypass Right Popliteal Artery to Lower Extremity Vein with Synthetic Substitute, Percutaneous Approach  041N3JQ - Bypass Left Popliteal Artery to Lower Extremity Artery with Synthetic Substitute, Percutaneous Approach  041N3JS - Bypass Left Popliteal Artery to Lower Extremity Vein with Synthetic Substitute, Percutaneous Approach Recovery after the Procedure Soon after the procedure, patients will be transferred to the recovery room where they will be monitored closely. Patients will be given fluids by a drip in veins until they feel or become well enough to sit up and consume fluids and foods by mouth. Within the first two days of the surgery, the epidural, drip (which is inserted during the operation to make sure you get enough fluids) and bladder catheter (used to drain the bladder) will be removed.

Physicians will close the incisions and cover it with a dressing. Swelling and drainage around your incisions is quite normal after the surgery and this will take some time to reduce down. In addition, the level of blood circulation in your legs and feet will be checked using a machine called a “Doppler” – which magnifies the sound of the blood flowing in your arteries. Patients will experience some pain from the incisions. The

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amount of pain is different for each person and will be based on the extent and severity of the procedure done. In addition, patients will also experience nausea or stomach problems (caused due to anesthesia) which can be controlled through medications. Patients in most normal cases can leave hospital within 7-10 days.

Patients can resume normal activities as soon as they feel well enough. However, heavy lifting and frequent stretching need to be avoided at first. Gentle exercises such as walking and cycling are recommended to keep blood pressure, diabetes and cholesterol levels under control. In addition, stopping the habit of smoking is also recommended as this will help protect arteries thereby reducing the chances of suffering heart attacks or strokes.

Vascular medical billing and coding can be complex and proper knowledge regarding appropriate coding and payer-specific medical billing guidelines are essential for correct and on-time reimbursement. The support of an experienced medical coding service provider can help in reporting bypass surgical procedures correctly for optimal reimbursement.

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