2025 CPT code 35691
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Feed
Transposition and/or reimplantation of vertebral to carotid artery.
Modifiers may be applicable, such as modifier 22 for increased procedural services, 50 for bilateral procedures, or other modifiers depending on specific circumstances.
Medical necessity must be established by documenting the symptoms, diagnostic tests confirming the vertebral artery blockage (e.g., angiogram, ultrasound), and the clinical rationale for surgical intervention to improve blood flow and prevent further complications such as stroke.
The surgeon is responsible for performing the entire procedure, including incision, exposure and preservation of the arteries, dividing and reimplanting the vertebral artery onto the carotid artery, and ensuring the patency of the graft.They also manage pre- and post-operative care.
In simple words: This surgery reroutes blood flow in the neck. The surgeon connects a part of the vertebral artery (which supplies blood to the back of the brain) to the carotid artery (which supplies blood to the front of the brain) to bypass a blockage and improve blood circulation to the brain.
This procedure involves exposing the vertebral artery, dividing it, and then anastomosing it to the carotid artery beyond a blockage to improve blood flow.The surgeon makes an incision above the clavicle, exposes the vertebral and carotid arteries, divides the vertebral artery above the stenosis, and then reimplants it onto the carotid artery to bypass the blockage.This allows for restored blood flow to the brain.
Example 1: A patient presents with severe stenosis of the vertebral artery causing insufficient blood flow to the brain. The surgeon performs a vertebral to carotid artery transposition to bypass the blockage., A patient experiences a stroke due to a vertebral artery blockage.A vertebral to carotid transposition is performed to restore blood flow and prevent further neurological damage., A patient has an aneurysm in the vertebral artery.A transposition to the carotid artery is performed to reroute blood flow and reduce the risk of rupture.
Documentation should include the pre-operative diagnosis, indication for the procedure, operative report detailing the procedure steps, including the location of the stenosis or blockage, the method of anastomosis, and confirmation of graft patency, and post-operative notes describing the patient's condition and any complications.
- Revenue Code: P2F
- Specialties:Vascular Surgery, Neurosurgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center