Hello,Any feedback is welcome as we are trying to figure our correct PCS coding in this scenario. If plaque is removed from the left common, left internal, and left external carotid, would PCS coding of all three (common, internal, and external) be appropriate? Or would the endarterectomy of the internal and external carotid only be reportable as this was the furthest anatomical sites from point (common carotid) of entry base on PCS coding guidelines B4.1c. Any thoughts or feedback is welcome.Thanks,Julia
An arteriotomy was made in the common carotid artery and extended through the plaque and into the internal carotid artery distally. An 8-French Argyle carotid shunt was placed in the common and internal carotid arteries.
The external iliac artery (EIA) and common femoral artery (CFA) are a single, continuous artery in the lower extremity. You can see that it is nicely illustrated in the picture below (in blue).
Basically, the external iliac artery continues down the leg to become the common femoral artery. In the example provided, the lesion is located in the femoral-external section, which is normally identified as a continuous vessel. So, it makes sense to assign a code to EIA. The EIA is further from the point of entry than the CFA, which happens to be the puncture site.
So, in the example provided, the precise location of the lesion within the femoral-external artery section has no bearing on the coding as long as this vessel that is being treated is normally identified as a continuous tubular body part. Unless it is a variant anatomy.
The left common carotid artery (LCCA), left internal carotid and left external carotid would not be considered a continuous vessel as the LCCA bifurcates into internal and external.
Really interesting that Coding Clinic has varying advices on this guideline.
The picture is from Dr. Z's Interventional Radiology.