Femoral Endarterectomy
3537135372wRVU: 18.12 — Profunda femoris (deep femoral) endarterectomy — standalone, not add-on (18.12 wRVU)35302wRVU: 20.82 — Superficial femoral artery endarterectomy (20.82 wRVU)35500wRVU: 6.28 — Harvest of vein graft for bypass (saphenous, add-on)
Right [left] common femoral artery occlusive disease [with critical limb ischemia / claudication / as inflow procedure for planned distal bypass]
Same
Right [left] common femoral endarterectomy with [bovine pericardial / saphenous vein / Dacron] patch angioplasty [and profundaplasty]
[Attending name], MD/DO
[Resident/PA name]
General endotracheal [/ spinal / regional]
The patient is a [age]-year-old [male/female] with [critical limb ischemia / lifestyle-limiting claudication / planned distal bypass requiring inflow correction] due to right [left] common femoral artery occlusive disease. Preoperative [CTA / duplex] demonstrated [significant stenosis / occlusion] of the [CFA / CFA with profunda femoris origin involvement / CFA bifurcation]. The risks, benefits, and alternatives were discussed and informed consent was obtained.
The common femoral artery was [heavily calcified / with soft plaque / with mixed plaque]. The disease extended from [the inguinal ligament level] to [the CFA bifurcation / the profunda femoris origin / the proximal SFA]. [The profunda femoris origin was [involved / uninvolved / with significant ostial stenosis].] [The SFA was [patent / occluded at its origin / with proximal disease].] Calcified plaque was removed; the endarterectomy plane was [well-defined / required careful feathering distally].
The patient was positioned supine. The groin was prepped and draped in sterile fashion. A vertical groin incision was made over the femoral pulse [at the inguinal ligament crease, extending distally along the course of the CFA]. The femoral sheath was incised. The common femoral artery, superficial femoral artery, and profunda femoris artery were individually dissected and controlled with vessel loops.
Systemic heparin [100 units/kg] was administered and ACT confirmed >250 seconds. Clamps were applied to the CFA proximally [at the inguinal ligament], SFA distally, and profunda femoris distally.
A longitudinal arteriotomy was made on the anterior surface of the CFA, extending from [2 cm above the CFA bifurcation] to [the SFA / profunda femoris origin / [X] cm onto the profunda]. The diseased plaque was identified in the subintimal plane. The endarterectomy was initiated proximally under direct vision; the specimen was removed as a single core. Distal endpoints on the SFA and profunda femoris were confirmed to be smooth and tacked down with [interrupted 6-0 Prolene tacking sutures / feathered smoothly without tacking].
[PROFUNDAPLASTY:] The arteriotomy was extended onto the profunda femoris for [X] cm. The profunda endarterectomy was performed, removing the ostial plaque. The distal profunda endpoint was confirmed to be smooth.
The arteriotomy was closed with a [bovine pericardial / saphenous vein / Dacron] patch sutured with running [6-0 Prolene]. The patch was fashioned to appropriate length and width. Before completing the closure, the vessels were flushed proximally and distally. Clamps were released sequentially — profunda first, then SFA, then the proximal CFA clamp — and hemostasis confirmed. A strong femoral pulse was confirmed by [palpation / continuous-wave Doppler].
Heparin was reversed with protamine [X mg IV]. The wound was irrigated. The femoral sheath was reapproximated with [absorbable sutures]. The subcutaneous tissue was closed with [3-0 Vicryl]. Skin was closed with [staples / 4-0 Monocryl].
None
Endarterectomy specimen (femoral plaque) sent to pathology
[X] mL
None / [Jackson-Pratt drain in groin wound]
The patient was taken to the PACU in stable condition. Post-operative ankle-brachial index [or toe pressures] were obtained. Ambulation was initiated on postoperative day 1.
Epic SmartPhrase Version
PREOPERATIVE DIAGNOSIS: Right/Left CFA occlusive disease, ***
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right/Left common femoral endarterectomy with *** patch [+ profundaplasty]
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: General/Spinal
INDICATIONS: .PTAGE-year-old .PTSEX with *** CFA disease, [CLI/claudication/inflow for bypass]. CTA/duplex: ***. Consent obtained.
FINDINGS: CFA ***. Plaque: soft/calcified/mixed. Profunda origin ***. SFA ***.
PROCEDURE:
Supine. Vertical groin incision. CFA, SFA, profunda isolated with vessel loops. Heparin *** units/kg, ACT >250. Clamps: proximal CFA, SFA, profunda. Longitudinal arteriotomy CFA to ***. Endarterectomy: plaque removed as single core. Distal endpoints SFA and profunda: smooth/tacked with 6-0 Prolene. [Profundaplasty: arteriotomy extended *** cm onto profunda; profunda endarterectomy performed.] *** patch closure with running 6-0 Prolene. Vessels flushed. Clamps released profunda → SFA → proximal CFA. Hemostasis confirmed. Strong femoral pulse by Doppler. Protamine *** mg IV. Wound irrigated. Closed.
EBL: *** mL
SPECIMENS: Endarterectomy plaque to pathology
COMPLICATIONS: None
DISPOSITION: PACU stable. ABI/toe pressures post-op.
Signed: .ME, .MYDEGREE
.TODAYVariants
Femoral Endarterectomy as Inflow for Distal Bypass
Femoral endarterectomy was performed as an inflow procedure prior to distal bypass grafting. After endarterectomy and patch closure, adequate inflow was confirmed by strong femoral pulse and Doppler signal. The distal bypass was then performed in standard fashion with the proximal anastomosis at the patched CFA or directly to the endarterectomized segment. Document the endarterectomy and bypass as separate procedures for billing (35371 + bypass CPT with modifier -51).
Bilateral Femoral Endarterectomy
Bilateral common femoral endarterectomy was performed in a single session. The right side was completed first, followed by the left, with sequential heparin dosing and ACT confirmation. Both groins were prepped simultaneously. Bill 35371 bilaterally with modifier -50. Document each side independently with separate findings, endarterectomy extents, patch materials, and completion assessments.
Charting Tips
- Document distal endpoints explicitly. The most common cause of early re-stenosis after femoral endarterectomy is a raised intimal flap at the distal SFA or profunda endpoint. Document that the endpoints were 'smooth and feathered' or describe tacking sutures placed. An intimal flap at the SFA origin is a technical failure.
- Document patch material and rationale. Vein patch reduces the risk of restenosis compared to primary closure and most surgeons use a patch routinely. Bovine pericardial patch has similar outcomes to vein. Primary closure is acceptable for large-diameter vessels. Document which material was used and why.
- Document post-endarterectomy Doppler assessment. Confirm a strong antegrade femoral signal after clamp release, loss of prior biphasic/monophasic signal, and restoration of triphasic or augmented Doppler waveform. ABI measurement in PACU is standard and should be ordered.
- Document lymphatic structure identification. The groin is lymphatic-rich and lymphocele or lymphorrhea is a common wound complication. Document that lymphatic channels were ligated with clips or ties during dissection. If a large lymphatic was encountered, document it specifically.
Billing Tips
- Common femoral endarterectomy: 35371 (14.93 wRVU, 90-day global). This is the standard code for endarterectomy of the common femoral artery, typically performed with patch angioplasty. The patch closure is included in 35371 — do not separately bill patch angioplasty.
- Profundaplasty: 35372 (18.12 wRVU, 90-day global). This is a standalone code — not an add-on — for endarterectomy of the profunda femoris (deep femoral) artery. Bill 35371 + 35372 with modifier -51 when both CFA and profunda endarterectomy are performed in the same session. The profunda femoris is the dominant outflow vessel in chronic SFA occlusive disease; document extent of profunda involvement, length of endarterectomy, and patch material.
- Superficial femoral artery (SFA) endarterectomy: 35302 (20.82 wRVU). Use when endarterectomy extends onto or involves the SFA beyond the CFA bifurcation. This is a separate, higher-weighted standalone code from 35371 — SFA endarterectomy involves a longer segment and greater technical complexity. Combined CFA + SFA: bill 35371 + 35302 with modifier -51. Document each vessel treated and extent of endarterectomy.
- Patch material does not change the CPT code. Saphenous vein patch, bovine pericardial patch, or Dacron patch — all included in 35371. If saphenous vein is harvested from a remote site specifically for patching (uncommon), 35500 may apply but is rarely separately billed for patch use.
- 90-day global period. Wound complications (groin infection, lymphocele, seroma) and post-op duplex surveillance are bundled. Graft occlusion requiring reoperation uses modifier -78.