How To Use CPT Code 35226

CPT 35226 describes the repair of an abnormal or injured blood vessel in the lower extremity. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 35226?

CPT 35226 is used to describe the repair of an abnormal or injured blood vessel in the lower extremity. This code is used when a provider makes an incision in the lower extremity to access the vessel requiring repair. The provider then dissects and moves soft tissue and vessels as necessary to reach the target area. The repair is performed using ligation or sutures, and the provider ensures normal blood flow through the repaired vessel. The wound is then irrigated and closed in multiple layers.

2. Official Description

The official description of CPT code 35226 is: ‘Repair blood vessel, direct; lower extremity.’

3. Procedure

1. The provider prepares the patient and makes an incision in the lower extremity to access the abnormal or injured blood vessel.
2. The provider dissects and moves soft tissue and vessels as necessary to reach the target area.
3. Bleeding is controlled manually, and the provider repairs the vessel using ligation or sutures.
4. The provider checks for normal blood flow through the repaired vessel, such as by using a Doppler probe.
5. Distal pulses are examined to ensure restoration of blood flow.
6. The wound is irrigated and closed in multiple layers.

4. Qualifying circumstances

CPT 35226 is used for the repair of an abnormal or injured blood vessel in the lower extremity. It should not be reported in conjunction with codes 33969, 33984, 33985, or 33986. The procedure is performed when there is a need to repair a blood vessel in the lower extremity, and the patient meets the necessary criteria for the procedure.

5. When to use CPT code 35226

CPT code 35226 should be used when a provider performs a direct repair of an abnormal or injured blood vessel in the lower extremity. It is appropriate to use this code when the repair is performed using ligation or sutures and when the procedure is not performed in conjunction with other specified codes.

6. Documentation requirements

To support a claim for CPT 35226, the provider must document the following information:

• Patient’s diagnosis and the need for repair of the blood vessel
• Details of the procedure, including the incision, dissection, repair method, and closure
• Confirmation of normal blood flow through the repaired vessel
• Examination of distal pulses to ensure restoration of blood flow
• Wound irrigation and closure details

7. Billing guidelines

When billing for CPT 35226, ensure that the procedure meets the criteria for repair of an abnormal or injured blood vessel in the lower extremity. Do not report CPT 35226 in conjunction with codes 33969, 33984, 33985, or 33986. It is important to follow the specific guidelines for reporting this code and to ensure accurate documentation to support the claim.

8. Historical information

CPT 35226 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A surgeon repairs an abnormal blood vessel in the lower extremity of a patient who suffered a traumatic injury.
2. A vascular specialist performs a direct repair of an injured blood vessel in the lower extremity of a patient with peripheral artery disease.
3. An interventional radiologist repairs an abnormal blood vessel in the lower extremity of a patient with a congenital vascular malformation.
4. A general surgeon performs a direct repair of an injured blood vessel in the lower extremity of a patient with atherosclerosis.
5. A vascular surgeon repairs an abnormal blood vessel in the lower extremity of a patient with a vascular tumor.
6. An orthopedic surgeon performs a direct repair of an injured blood vessel in the lower extremity of a patient with a fracture.
7. A plastic surgeon repairs an abnormal blood vessel in the lower extremity of a patient undergoing reconstructive surgery.
8. A cardiothoracic surgeon performs a direct repair of an injured blood vessel in the lower extremity of a patient undergoing coronary artery bypass grafting.
9. An interventional cardiologist repairs an abnormal blood vessel in the lower extremity of a patient with peripheral artery disease.
10. A vascular surgeon performs a direct repair of an injured blood vessel in the lower extremity of a patient with a deep vein thrombosis.