Carotid – Subclavian Bypass Before a TEVAR

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Question:

I performed a carotid-subclavian bypass with vein in preparation for TEVA that was then performed on a subsequent day. How are these two procedures reported?

Answer:

The carotid-subclavian bypass is reported with 35606 as the first stage of this two stage procedure. Since this has a 90 day global and the TEVAR is preformed within that global period, all the TEVAR codes (main body deployment, catheterization, exposure, etc) would be reported with a 58 modifier to indicate a staged procedure. The operative note for 35606 should document the staged nature of the procedures. No modifier is needed on the 35606, assuming the patient is not already in a global period for an earlier procedure.

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