thrombectomy, open vs percutaneous

I am looking for clarification of how to code a thrombectomy from an AV graft. The surgeon dissected down to the graft and the graft was dissected out proximally and distally. The graft was opened transversely with a blade. Then a Fogarty catheter was used to retrieve the thrombus from the  arterial side of the graft. In discussion with coders, they feel this is a percutaneous procedure since the clot was retrieved with a catheter.  is this an open or percutaneous thrombectomy?


  • To me, what you are describing is an open procedure based on the definitions of the approaches:

    Percutaneous is entry by puncture or minor incision

    Open is cutting through skin or mucous membranes to expose the site

    What you have described is that the surgeon has made an incision to get to the graft and then made an incision in the graft...the method of clot retrieval is irrelevant to me in this case. I did notice in our 3M encoder than beside percutaneous it has transcatheter in parenthesis).

    Will be interested to see what other's say.


  • Great question. I believe OPEN Approach
    The key word is necessary in the PCS definition:An open approach is defined as cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure.
     >A 5-cm skin incision overlying the antecubital fossa was then performed and deepened through the subcutaneous tissue and fat. The biceps aponeurosis was incised over the brachial pulse. The brachial artery was circumferentially dissected to its bifurcation into the ulnar and radial arteries.
    The brachial artery was controlled with silastic vessel loops and a transverse arteriotomy was performed. (this is why its necessary to be an open approach)
    Clot was extruded and good inflow was established.
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