2025 CPT code 35508
Effective Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Feed
Bypass graft, with vein; carotid-vertebral
Modifiers may be applicable to this code to indicate specific circumstances, such as increased procedural services (modifier 22), bilateral procedures (modifier 50), or staged or related procedures (modifier 58). Refer to current CPT coding guidelines for appropriate modifier usage.
Medical necessity must be established by demonstrating that the procedure is necessary to treat a significant blockage or other abnormality affecting blood flow in the carotid and vertebral arteries, and that less invasive options are unsuitable or have failed.
The surgeon makes an incision in the neck to access the carotid and vertebral arteries. A vein graft may be harvested from another part of the body. Clamps are applied to the arteries, which are then transected to attach the graft. Blood flow is restored, and the incision is closed.
In simple words: This procedure creates a detour around a blocked blood vessel in the neck using a healthy vein from elsewhere in the body, connecting the carotid artery to the vertebral artery to restore blood flow.
This code describes a surgical procedure where a blockage in a blood vessel is bypassed by inserting a vein graft that connects the common carotid artery to a portion of the vertebral artery.
Example 1: A patient with severe stenosis (narrowing) of the vertebral artery causing symptoms of vertebrobasilar insufficiency undergoes a carotid-vertebral bypass using a saphenous vein graft., A patient with a vertebral artery dissection (tear) requires a carotid-vertebral bypass to restore blood flow to the posterior circulation of the brain., A patient with a carotid artery blockage and inadequate collateral circulation to the vertebral artery requires a carotid-vertebral bypass to prevent stroke.
Documentation should include operative details such as the location and extent of the blockage, type of graft used (e.g., saphenous vein, radial artery), and any complications encountered. Preoperative imaging studies and medical necessity should also be documented.
** As of 2017, this code is included in the Inpatient Only (IPO) list.
- Revenue Code: P2F: MAJOR PROCEDURE, CARDIOVASCULAR - OTHER