2025 CPT code 35585
(Active) Effective Date: N/A Revision Date: N/A Surgery - Vascular Procedures Surgery Feed
In situ vein bypass from the femoral artery to the anterior tibial, posterior tibial, or peroneal artery.
Modifiers may be appended to 35585 to indicate multiple procedures (51), bilateral procedures (50), or distinct procedural services (59) if applicable.
The procedure is medically necessary when conservative management has failed to relieve symptoms and the patient has significant peripheral artery disease with compromised blood flow to the lower extremity, leading to claudication, rest pain, or tissue loss.The decision to perform the procedure is based on the severity of the disease, the patient's overall health, and the expected benefit of the procedure.
A vascular surgeon or other qualified physician performs this procedure. Responsibilities include patient evaluation, preoperative planning, surgical technique, postoperative care, and monitoring of the patient's progress.
In simple words: The doctor uses a vein from your leg to create a detour around a blocked artery in your lower leg, improving blood flow to your foot and leg.
This CPT code represents the surgical procedure of creating a vein bypass graft using the patient's own saphenous vein, in situ (in its original location), to redirect blood flow around a blocked or diseased artery. The bypass is specifically from the femoral artery to either the anterior tibial, posterior tibial, or peroneal artery in the lower leg.The procedure involves harvesting a segment of the saphenous vein, preparing it for use as a conduit, and then creating anastomoses (connections) between the vein and the femoral artery and the target artery in the lower leg.This restores blood flow to the lower extremity.
Example 1: A 70-year-old male patient presents with critical limb ischemia (CLI) in his right leg due to severe peripheral artery disease (PAD).Angiography reveals significant stenosis of the right femoral artery and complete occlusion of the right posterior tibial artery.An in situ vein bypass using the right greater saphenous vein is performed from the right femoral artery to the right posterior tibial artery using code 35585., A 65-year-old female patient with diabetes and PAD experiences intermittent claudication (pain during exercise) in her left leg.Doppler ultrasound shows significant narrowing of the left superficial femoral artery and the left anterior tibial artery.A decision is made for an in situ vein bypass from the left femoral artery to the left anterior tibial artery to alleviate her symptoms. Code 35585 is reported., A 55-year-old male patient with a history of smoking presents with rest pain in his right foot due to PAD.Angiography demonstrates significant disease in multiple vessels of the right leg.The surgeon decides to perform a femoropopliteal bypass using a synthetic graft followed by a separate in situ vein bypass using the patient's saphenous vein from the femoral artery to the peroneal artery to restore perfusion to the foot. Code 35585 is used for the in situ bypass, likely along with another code for the femoropopliteal bypass and potentially modifier 59.
Detailed operative report including the type of bypass (in situ), the vessels involved (femoral artery and the target artery in the lower leg), the length of the vein graft, and any complications encountered during or after surgery. Preoperative and postoperative angiograms or other imaging studies demonstrating the location and extent of the disease.Complete patient history including risk factors for PAD (e.g., smoking, diabetes, hypertension).Documentation of the medical necessity for the procedure and expected outcomes.
** This code is specific to in situ vein bypass grafts; different codes apply for other types of bypass grafts (e.g., using synthetic materials) or different arterial locations.Always refer to the most current CPT codebook for accurate coding and reimbursement.
- Payment Status: Active
- Modifier TC rule: TC (Technical Component) modifier would not typically be used with this code.This procedure is entirely surgical and does not generally separate into professional and technical components.
- Specialties:Vascular Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center