2025 CPT code 35642
(Active) Effective Date: N/A Revision Date: N/A Surgery - Vascular bypass grafts Surgery Feed
Bypass graft, carotid-vertebral artery, using a synthetic graft.
Modifiers may be applicable depending on the circumstances of the procedure and may include (but are not limited to): 50 (bilateral procedure), 59 (distinct procedural service), 78 (unplanned return to OR), 22 (increased procedural service).
Medical necessity for this procedure is established by the presence of significant vertebral artery stenosis or occlusion causing clinically significant neurological deficits or a high risk of stroke. This requires detailed documentation of symptoms, imaging findings confirming the stenosis, and lack of alternatives.
The vascular surgeon is responsible for performing the procedure, including pre-operative assessment, surgical technique, post-operative monitoring, and follow-up care.
In simple words: A surgeon creates a detour around a blocked artery in the neck that supplies blood to the brain using a man-made tube (graft). This reroutes blood flow to bypass the blockage.
This procedure involves creating a bypass around a blocked section of the vertebral artery using a synthetic graft.The surgeon connects one end of the graft to the carotid artery and the other end to the vertebral artery beyond the blockage, restoring blood flow to the brain.This may involve making incisions in the neck, preparing the graft, clamping arteries, creating openings, suturing the graft in place, checking for leaks and assessing graft patency (e.g., arteriography, ultrasound).
Example 1: A 65-year-old male presents with symptoms of vertebrobasilar insufficiency due to a stenosis in the vertebral artery.A carotid-vertebral bypass with a synthetic graft is performed to restore blood flow., A 70-year-old female with a history of atherosclerosis develops acute vertebral artery occlusion.An emergency carotid-vertebral bypass with a synthetic graft is performed to re-establish blood flow to the posterior circulation., A 58-year-old male presents with a traumatic injury to the vertebral artery.A carotid-vertebral bypass with a synthetic graft is performed to repair the damage and prevent further ischemic complications.
* Preoperative assessment including imaging studies (e.g., angiography, CT angiography) to confirm the diagnosis and assess the extent of the lesion.* Intraoperative findings, including the type and size of the graft used, the location of anastomoses, and the assessment of blood flow.* Postoperative course, including complications, and follow-up imaging studies to confirm the patency of the graft.
** Always refer to the most current CPT codebook and payer guidelines for accurate coding and reimbursement.Ensure proper documentation supports the medical necessity and the technical aspects of the procedure.This is complex surgery; accurate coding requires precise documentation and clinical details.
- Revenue Code: 0001, 0002 (depending on the place of service and other factors)
- RVU: The RVUs for this code vary depending on the geographic location, facility type (inpatient vs. outpatient), and other factors. Consult your local payer's fee schedule.
- Global Days : Global surgical package days will depend on payer specific policies.Check individual payer's guidelines for information.
- Payment Status: Active
- Modifier TC rule: Technical component (TC) modifier is usually not applicable to this code.
- Fee Schedule : Historical fee schedules will vary significantly based on the payer, location, year and other factors. Consult payer-specific fee schedules for specific details.
- Specialties:Vascular Surgery, Neurosurgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center