How To Use CPT Code 35538

CPT 35538 describes the procedure for bypass grafting using a vein to connect the aorta to portions of both iliac arteries. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 35538?

CPT 35538 can be used to describe the bypass grafting procedure in which a vein is used to create a connection between the aorta and portions of both iliac arteries. This code is used when the provider performs the bypass grafting procedure using a vein graft.

2. Official Description

The official description of CPT code 35538 is: ‘Bypass graft, with vein; aortobi-iliac.’ This code should not be reported in conjunction with CPT code 35537, and if the bypass graft is performed with a synthetic graft, CPT code 35638 should be used instead.

3. Procedure

1. The provider begins by making an incision in the abdomen and/or retroperitoneum to access the aorta and both iliac arteries.
2. A pathway is created between the target anastomosis sites.
3. A graft is harvested from elsewhere in the body, such as a vein.
4. Clamps are applied to the aorta and the iliac arteries.
5. One end of the graft is attached to the aorta, and another end is attached to the first iliac artery.
6. Another graft is attached to the vein conduit, and the other end is attached to the second iliac artery.
7. The clamps on the vein conduit are removed to restore normal blood flow.
8. The provider closes the skin incision in layers after ensuring hemostasis.
9. The provider checks for normal blood flow pattern through the repaired vessels, such as by using a Doppler probe.

4. Qualifying circumstances

CPT 35538 is performed when there is a blockage in a blood vessel that requires bypass grafting. The procedure involves connecting the aorta to portions of both iliac arteries using a vein graft. It is important to note that CPT code 35538 should not be reported in conjunction with CPT code 35537, and if a synthetic graft is used instead of a vein graft, CPT code 35638 should be used.

5. When to use CPT code 35538

CPT code 35538 should be used when the provider performs a bypass grafting procedure using a vein graft to connect the aorta to portions of both iliac arteries. It is important to ensure that the procedure meets the specific criteria outlined in the official description of the code.

6. Documentation requirements

To support a claim for CPT code 35538, the provider must document the following information:

• Patient’s diagnosis and the need for bypass grafting
• Details of the procedure, including the use of a vein graft
• Date of the procedure
• Specific anatomical sites involved in the bypass grafting
• Confirmation of normal blood flow pattern through the repaired vessels
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 35538, ensure that the procedure meets the specific criteria outlined in the official description. It is important to note that CPT code 35538 should not be reported in conjunction with CPT code 35537. If a synthetic graft is used instead of a vein graft, CPT code 35638 should be used. Consider the appropriate use of modifiers if necessary.

8. Historical information

CPT code 35538 was added to the Current Procedural Terminology system on January 1, 2007. It is important to stay updated with any changes or revisions to the code.

9. Examples

1. A provider performs a bypass grafting procedure using a vein graft to connect the aorta to portions of both iliac arteries in a patient with peripheral arterial disease.
2. A patient with a blocked blood vessel undergoes a bypass grafting procedure using a vein graft to restore normal blood flow between the aorta and portions of both iliac arteries.
3. A provider performs a bypass grafting procedure using a vein graft to treat a patient with atherosclerosis in the aorta and iliac arteries.
4. A patient with a blockage in the iliac arteries undergoes a bypass grafting procedure using a vein graft to improve blood flow.
5. A provider performs a bypass grafting procedure using a vein graft to treat a patient with aortic occlusive disease.
6. A patient with a blocked blood vessel in the iliac arteries undergoes a bypass grafting procedure using a vein graft to restore blood flow.
7. A provider performs a bypass grafting procedure using a vein graft to treat a patient with chronic mesenteric ischemia.
8. A patient with a blockage in the aorta and iliac arteries undergoes a bypass grafting procedure using a vein graft to improve blood flow.
9. A provider performs a bypass grafting procedure using a vein graft to treat a patient with iliac artery stenosis.
10. A patient with a blocked blood vessel in the aorta undergoes a bypass grafting procedure using a vein graft to restore normal blood flow.