2025 CPT code 35656
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Cardiovascular System - Bypass Graft Procedures Other Than Vein Surgery Feed
This code represents the creation of a femoral-popliteal bypass graft using a synthetic material rather than a vein.
Modifiers may be applicable depending on the circumstances of the procedure.For instance, modifier 51 (multiple procedures) might be used if other procedures are performed concurrently, and modifier 22 (increased procedural services) may be appropriate if the procedure is significantly more complex than usual.
Medical necessity for a femoral-popliteal bypass is established when conservative management (lifestyle modifications, medical therapy) has failed to alleviate symptoms of critical limb ischemia (rest pain, non-healing ulcers, tissue loss) or when there's evidence of acute limb-threatening ischemia.Documentation must support the severity of the disease and the necessity of surgical intervention.
The clinical responsibility for this procedure lies with a vascular surgeon or a qualified surgeon experienced in peripheral vascular surgery. The surgeon's responsibilities encompass the entire procedure, from pre-operative planning and patient assessment to the actual surgical intervention, post-operative monitoring, and ensuring patient recovery.
- Surgery
- Surgical Procedures on the Cardiovascular System > Bypass Graft Procedures Other Than Vein
In simple words: This surgery uses a man-made tube (graft) to redirect blood flow around a blockage in an artery in the leg, restoring blood flow to the lower leg and foot.
CPT code 35656 describes the surgical procedure of creating a femoral-popliteal bypass graft using a synthetic material. This involves bypassing a blockage in the femoral artery by rerouting blood flow around the obstruction to the popliteal artery using a synthetic graft.The procedure includes surgical incision, preparation of the graft, application of clamps to the femoral artery, incision of the femoral artery above the blockage, suturing one end of the synthetic graft, tunneling the graft under the skin, creating an opening in the popliteal artery, attaching the graft (end-to-end or side-to-side), releasing clamps, checking for leaks, and potentially assessing graft patency via arteriography or ultrasound.Wound closure and drainage placement may also be included.
Example 1: A 65-year-old male presents with severe claudication (leg pain) and reduced ankle-brachial index (ABI) due to a significant blockage in his left femoral artery.A femoral-popliteal bypass with a synthetic graft is performed to restore blood flow to the lower extremity., A 72-year-old female with diabetes and peripheral arterial disease experiences rest pain and non-healing ulcers on her right foot due to critical limb ischemia.Femoral-popliteal bypass surgery with synthetic graft is necessary to improve blood supply and prevent potential amputation., A 58-year-old male with a history of smoking and hypertension develops acute limb ischemia following a thrombosis in his left femoral artery.Emergency femoral-popliteal bypass surgery using a synthetic graft is required to salvage the limb.
Detailed patient history and physical examination findings, including symptoms of peripheral artery disease (PAD), ABI measurements, results of non-invasive vascular studies (e.g., Doppler ultrasound, angiography), operative report detailing the surgical technique, type of graft used, location of anastomoses, intraoperative findings, postoperative course, and pathology results if applicable.
** The choice between a vein graft and a synthetic graft depends on various factors, including the patient's overall health, the location and extent of the blockage, and the surgeon's preference.Detailed documentation is crucial for accurate coding and reimbursement. Always consult the most up-to-date CPT manual and payer guidelines.
- Revenue Code: P2F (MAJOR PROCEDURE, CARDIOVASCULAR - OTHER)
- RVU: Information not available in provided sources.Refer to current Medicare fee schedules and other payer-specific information for RVU values.
- Global Days: Information not available in provided sources. The global period for this procedure would be determined by payer-specific guidelines and may vary.
- Payment Status: Active
- Modifier TC rule: Information not available in provided sources. The use of TC modifiers is dependent on specific payer guidelines and the nature of the procedure.
- Fee Schedule: Information not available in provided sources. Refer to historical Medicare fee schedules and other payer-specific data.
- Specialties:Vascular Surgery, General Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center