E672

PDF page 675 / Q17

CARDIOVASCULAR SURGICAL PROCEDURES
 ARTERIES
                                                                                                Asst   Surg      Anae
# R809 Femoral-popliteal endarterectomy ...........................................             10      759.60    10
# R878 Subintimal dissection for recanalization of femoral/popiteal/
         tibial arterial occlusive disease............................................          10      759.60    10
# R879 Subintimal dissection for recanalization of iliac/aorta arterial
         occlusive disease ................................................................     10      759.60    10
# E815   - angioplasty remote from subintimal dissection site, to
           R878 and R879...........................................................add                  398.15
         Note:
         E815 includes placement of stent(s) or any other device(s), when rendered.
         Payment rules:
         1.R878 is not eligible for payment same patient same day as R809, R791, R794, R787, R780
           or R797.
         2.R879 is not eligible for payment same patient same day as R860 or R861.
         3.R878 and R879 include catheter placement, angiography and any image guidance.
           Obtaining and interpreting any images in conjunction with R878 and R879 are not eligible for
           payment to any physician.
         4.Bilateral procedures for R878 or R879 are payable only as separate services when
           subintimal dissection is performed using separate bilateral incisions.
    Femoro-popliteal
# R791 - with saphenous vein............................................................        10     1077.25    10
# E672   - composite femoral popliteal/tibial bypass (vein PFPE,
           dacron)........................................................................add           133.40
# R794 - with prosthetic graft .............................................................    10      733.15    10
    Femoro-anterior/posterial tibial/peroneal bypass graft
# R787 - with saphenous or arm vein, with or without splicing ..........                        10     1265.00    10
# E672   - composite femoral popliteal/tibial bypass (vein PFPE,
           dacron)........................................................................add           133.40
# R780 - with prosthetic graft .............................................................    10      878.00    10

PDF page 675 / Q17

Note:
         R791, E672, R794, R787, E672, R780 with or without endarterectomy.
# R810 Popliteal aneurysm ..................................................................    7       805.65    10
# R812 Peripheral arteries other than listed - aneurysm......................                   7       410.45    10
# R813 Embolectomy - artery or graft - as sole procedure ..................                     7       769.55    10
# R867 Thrombectomy - artery or graft - as sole procedure ................                      7       490.00    10
# R866 Gastric devascularization - as sole procedure.........................                   10      549.65    10

Master, record 1368. Record Layout PDF, page 1.

E67220250401999999990000133400000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.