How To Use CPT Code 35516

CPT 35516 describes a procedure known as bypass graft, with vein, specifically connecting the subclavian artery to a portion of the axillary artery using a vein graft. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 35516?

CPT 35516 is a code used to describe a surgical procedure in which a bypass graft is performed to bypass a blockage in a blood vessel. In this specific case, the procedure involves connecting the subclavian artery to a portion of the axillary artery using a vein graft. The purpose of this procedure is to restore normal blood flow and circulation in the affected area.

2. Official Description

The official description of CPT code 35516 is: ‘Bypass graft, with vein; subclavian-axillary.’ This code specifically refers to the surgical procedure in which a vein graft is used to create a bypass between the subclavian artery and a portion of the axillary artery.

3. Procedure

1. The surgeon begins by making an incision above the collarbone to access the subclavian and axillary arteries.
2. Tissue between the target anastomosis sites is cleared to create a pathway for the bypass graft.
3. A graft, typically harvested from another part of the patient’s body, is prepared for the procedure.
4. The surgeon applies clamps to the subclavian artery to temporarily stop blood flow.
5. An opening is created in the subclavian artery, and one end of the graft is attached to this opening.
6. Clamps are then applied to the axillary artery to temporarily stop blood flow in that area.
7. An opening is created in the axillary artery, and the other end of the graft is attached to this opening.
8. The clamps are removed to restore normal blood flow, and the surgeon ensures that there is no bleeding or leakage.
9. The incision is closed in layers, and appropriate measures are taken to ensure proper healing and hemostasis.

4. Qualifying circumstances

CPT 35516 is typically performed on patients who have a blockage or narrowing in the subclavian or axillary arteries that requires surgical intervention. The procedure is performed by a qualified surgeon who has the necessary expertise and training in vascular surgery. The patient must meet specific criteria and undergo appropriate preoperative evaluation to determine their eligibility for the procedure.

5. When to use CPT code 35516

CPT code 35516 should be used when a surgeon performs a bypass graft procedure using a vein graft to connect the subclavian artery to a portion of the axillary artery. This code is specific to this particular procedure and should not be used for other types of bypass grafts or vascular procedures.

6. Documentation requirements

To support a claim for CPT 35516, the surgeon must document the following information:

• Patient’s medical history and diagnosis necessitating the bypass graft procedure
• Details of the procedure, including the incision site, graft used, and specific steps performed
• Any complications or unexpected findings during the procedure
• Postoperative care instructions and follow-up plans
• Signature of the surgeon performing the procedure

7. Billing guidelines

When billing for CPT 35516, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The surgeon should use the appropriate documentation and coding guidelines to accurately report the procedure. It is also important to follow any additional billing guidelines provided by insurance companies or regulatory bodies to ensure proper reimbursement.

8. Historical information

CPT code 35516 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone no significant updates or changes since its addition.

9. Examples

1. A patient with a blockage in the subclavian artery undergoes a bypass graft procedure using a vein graft to connect the subclavian artery to a portion of the axillary artery.
2. A surgeon performs a bypass graft procedure on a patient with a narrowed axillary artery, using a vein graft to restore normal blood flow.
3. A patient with a history of vascular disease undergoes a bypass graft procedure to bypass a blockage in the subclavian-axillary region.
4. A surgeon performs a bypass graft procedure on a patient with a congenital vascular anomaly affecting the subclavian and axillary arteries.
5. A patient with a traumatic injury to the subclavian-axillary region undergoes a bypass graft procedure to repair the damaged blood vessels.
6. A surgeon performs a bypass graft procedure on a patient with atherosclerosis affecting the subclavian and axillary arteries.
7. A patient with a history of failed previous vascular interventions undergoes a bypass graft procedure to restore blood flow in the subclavian-axillary region.
8. A surgeon performs a bypass graft procedure on a patient with a tumor compressing the subclavian and axillary arteries.
9. A patient with a congenital vascular anomaly undergoes a bypass graft procedure to improve blood flow in the subclavian-axillary region.
10. A surgeon performs a bypass graft procedure on a patient with a chronic inflammatory condition affecting the subclavian and axillary arteries.