How To Use CPT Code 35390

CPT 35390 describes the reoperation procedure for carotid thromboendarterectomy that is performed more than one month after the original operation. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 35390?

CPT 35390 can be used to describe the reoperation procedure for carotid thromboendarterectomy that is performed more than one month after the initial operation. This code is used when the provider removes thrombus from a carotid artery through a neck incision after a previous thromboendarterectomy on the same vessel.

2. Official Description

The official description of CPT code 35390 is: ‘Reoperation, carotid, thromboendarterectomy, more than one month after the original operation (List separately in addition to code for primary procedure).’ This code should be used in conjunction with CPT code 35301, which represents the primary procedure.

3. Procedure

1. The provider prepares the patient for the reoperation procedure, ensuring that they are appropriately prepped and anesthetized.
2. An incision is made in the neck to access the carotid artery.
3. Clamps are placed on both sides of the affected area to stop blood flow, and a temporary vascular shunt may be placed to maintain blood flow during the procedure.
4. If a graft is needed, a vein is harvested from the patient’s body, and the graft is prepared.
5. The provider opens the carotid artery and performs an endarterectomy to remove the portion of the artery where the thrombus or atherosclerosis has formed.
6. A synthetic or homogenous patch graft is placed, and the arterial opening is closed with sutures.
7. The shunt and clamps are removed to restore normal blood flow, and the skin incision is closed in layers.

4. Qualifying circumstances

CPT 35390 is used when a reoperation is performed for carotid thromboendarterectomy more than one month after the original operation. This procedure is typically performed on patients who have previously undergone thromboendarterectomy and require further intervention to remove thrombus from the carotid artery.

5. When to use CPT code 35390

CPT code 35390 should be used when a reoperation is performed for carotid thromboendarterectomy more than one month after the initial operation. It is important to ensure that the primary procedure code, such as CPT code 35301, is also reported to indicate the initial operation.

6. Documentation requirements

To support a claim for CPT code 35390, the provider must document the following information:

• Confirmation of the previous thromboendarterectomy procedure
• Date of the original operation
• Date of the reoperation
• Description of the procedure performed during the reoperation
• Details of any additional interventions, such as the use of a vascular shunt or graft
• Confirmation of the closure of the arterial opening and the removal of the shunt and clamps
• Signature of the provider performing the reoperation

7. Billing guidelines

When billing for CPT code 35390, it is important to ensure that the procedure meets the qualifying circumstances of being a reoperation for carotid thromboendarterectomy more than one month after the original operation. This code should be reported in addition to the primary procedure code, such as CPT code 35301. It is an add-on code, so it should not be reported without the appropriate primary code.

8. Historical information

CPT code 35390 was added to the Current Procedural Terminology system on January 1, 1994. The code has not undergone any updates since its addition. It is important to note that Medicare considers this procedure as an Inpatient Only (IPO) service.

9. Examples

1. A provider performs a reoperation for carotid thromboendarterectomy on a patient who had the initial operation one month ago.
2. A patient undergoes a reoperation for carotid thromboendarterectomy more than one month after the original operation, with the use of a synthetic patch graft.
3. A provider performs a reoperation for carotid thromboendarterectomy on a patient who had the initial operation one month ago, with the use of a vein graft.
4. A patient requires a reoperation for carotid thromboendarterectomy within one day after the original operation, and the provider performs the procedure without the use of a graft.
5. A provider performs a reoperation for carotid thromboendarterectomy within one day after the original operation, with the use of a vascular shunt during the procedure.
6. A patient undergoes a reoperation for carotid thromboendarterectomy within one day after the original operation, with the use of a synthetic patch graft.
7. A provider performs a reoperation for carotid thromboendarterectomy within one day after the original operation, with the use of a vein graft.
8. A patient requires a reoperation for carotid thromboendarterectomy within one day after the original operation, and the provider performs the procedure without the use of a graft.