by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC
Question:
Patient had emergency bypass due to multiple dog bite wounds. Two bypass procedures were required, radial-radial & ulnar-ulnar. Would we code 35523 X’s 2 or 37799 & compare to 35525?
Cut down onto the radial artery. Radial artery was dissected free from structures proximally. There was obvious injury to the radial artery. Complete disruption was a through and through puncture injury on the radial artery at the antecubital fossa. No brachial artery at the antecubital fossa. Total bypass length 4 and half centimeters onto. It was a functional end-to-end anastomosis. Ulnar artery lot of tissue injury, muscle tearing from the dog injury and the ulnar artery was below the biceps muscle. Dissected it free from surrounding structures. There is a crush injury I then used reverse greater saphenous vein and did end-to-end anastomosis on both the proximal ulnar artery and the distal ulnar artery for total bypass length approximately 2-1/2 cm.
Answer:
There are not specific codes for those. We would consider unlisted for the ulnar bypass with saphenous vein. We can’t tell if radial had vein bypass so, may consider a repair code of 35205 if direct or 35236 if with vein.
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