2025 CPT code 35587
(Active) Effective Date: N/A Revision Date: N/A Surgery - Vascular bypass procedures Surgery Feed
In situ vein bypass; popliteal-tibial, peroneal artery.
Modifiers 51 (Multiple procedures), 59 (Distinct procedural service), and anatomical modifiers may be applicable depending on the circumstances of the procedure.Consult the CPT codebook and NCCI edits for specific guidance.
Medical necessity for this procedure is established by the presence of significant symptoms related to arterial insufficiency, such as claudication (pain on walking), rest pain, or tissue loss (ulceration or gangrene), along with objective evidence of arterial blockage on angiography or other imaging studies. The procedure is medically necessary to restore blood flow and prevent limb loss or other serious complications.
The surgeon is responsible for all aspects of the procedure, including pre-operative assessment, incision and exposure of the vessels, preparation of the vein graft, creation of the anastomoses, completion of the bypass, hemostasis, and closure of the incisions.
In simple words: The doctor uses a vein from the patient's leg to create a new pathway around a blocked artery in the lower leg, improving blood flow.
This CPT code describes an in situ vein bypass procedure where the patient's saphenous vein is used to create a bypass from the popliteal artery to either the tibial or peroneal artery to circumvent a blockage. The procedure involves accessing the popliteal artery behind the knee, preparing the saphenous vein (including division of branches, flushing, and valve disruption), and creating anastomoses between the vein and the target artery (tibial or peroneal).The procedure aims to restore blood flow to the lower extremities.
Example 1: A patient presents with critical limb ischemia due to a blockage in the peroneal artery.The surgeon performs an in situ popliteal-peroneal bypass using the patient's saphenous vein to restore blood flow., A patient with peripheral artery disease experiences claudication and reduced pulses in the lower leg.Angiography reveals a significant blockage in the posterior tibial artery.The surgeon performs an in situ popliteal-tibial bypass using the patient's saphenous vein., A patient with diabetes and peripheral vascular disease has a blockage in both the peroneal and posterior tibial arteries.The surgeon performs separate in situ bypasses for each vessel, using the saphenous vein for each bypass.Modifier 59 (Distinct procedural service) is appended to the second procedure code.
Preoperative evaluation including patient history, physical examination documenting symptoms and pulses, and imaging studies (angiography) demonstrating the location and extent of the blockage. Operative report detailing the procedure performed (including type of bypass, location of anastomoses, graft material used, and any complications). Postoperative care notes, including assessment of pulses, wound healing, and any complications.
** The choice between using the tibial or peroneal artery as the distal anastomosis site depends on the location and severity of the blockage.
- Revenue Code: P2F (MAJOR PROCEDURE, CARDIOVASCULAR - OTHER)
- Payment Status: Active
- Modifier TC rule: No TC modifier is typically used for this code.
- Specialties:Vascular Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center