How To Use CPT Code 35556

CPT 35556 describes the procedure for bypass grafting using a vein to connect the femoral artery to a portion of the popliteal artery. 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 35556?

CPT 35556 can be used to describe the procedure in which a healthcare provider bypasses a blockage in a blood vessel by inserting a graft that connects the femoral artery to a portion of the popliteal artery using a vein graft. This code is used when the provider performs the bypass grafting procedure.

2. Official Description

The official description of CPT code 35556 is: ‘Bypass graft, with vein; femoral-popliteal.’

3. Procedure

1. The healthcare provider prepares the patient and administers anesthesia.
2. An incision is made in the groin to access the femoral artery.
3. Another incision is made near the knee to expose the popliteal artery.
4. The provider creates a pathway between the femoral and popliteal arteries.
5. A graft is harvested from another part of the body.
6. The provider applies clamps to the femoral artery.
7. An opening is created in the femoral artery and one end of the graft is attached.
8. The graft is passed through the pathway to the popliteal artery.
9. Clamps are applied to vessels as needed.
10. An opening is created in the popliteal artery and the other end of the graft is attached.
11. The clamps are removed to restore normal blood flow.
12. The incisions are closed in layers after ensuring hemostasis.

4. Qualifying circumstances

Patients eligible for CPT 35556 are those who require a bypass graft to address a blockage in the femoral-popliteal artery. The procedure is performed by a healthcare provider who has the necessary qualifications and expertise. The use of a vein graft is a key qualifying circumstance for this code.

5. When to use CPT code 35556

CPT code 35556 should be used when a healthcare provider performs a bypass graft procedure using a vein to connect the femoral artery to a portion of the popliteal artery. This code is appropriate for reporting this specific procedure and should not be used for other bypass graft procedures.

6. Documentation requirements

To support a claim for CPT 35556, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for the bypass graft procedure
• Details of the procedure, including the use of a vein graft
• Date of the procedure
• Incision sites and anatomical structures involved
• Specific steps performed during the procedure
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 35556, ensure that the procedure meets the criteria outlined in the official description. Use the appropriate CPT code based on the specific bypass graft procedure performed. It is important to follow the billing guidelines provided by the payer to ensure accurate reimbursement.

8. Historical information

CPT 35556 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone changes related to Medicare reimbursement, specifically being added to the Inpatient Only (IPO) list in 2017.

9. Examples

1. A surgeon performing a bypass graft procedure using a vein to connect the femoral artery to the popliteal artery in a patient with peripheral arterial disease.
2. An interventional radiologist performing a bypass graft procedure using a vein to connect the femoral artery to the popliteal artery in a patient with atherosclerosis.
3. A vascular surgeon performing a bypass graft procedure using a vein to connect the femoral artery to the popliteal artery in a patient with a blockage.
4. An orthopedic surgeon performing a bypass graft procedure using a vein to connect the femoral artery to the popliteal artery in a patient with a traumatic injury.
5. A cardiovascular surgeon performing a bypass graft procedure using a vein to connect the femoral artery to the popliteal artery in a patient with peripheral vascular disease.
6. A vascular surgeon performing a bypass graft procedure using a vein to connect the femoral artery to the popliteal artery in a patient with atherosclerosis.
7. An interventional radiologist performing a bypass graft procedure using a vein to connect the femoral artery to the popliteal artery in a patient with a blockage.
8. An orthopedic surgeon performing a bypass graft procedure using a vein to connect the femoral artery to the popliteal artery in a patient with a traumatic injury.
9. A cardiovascular surgeon performing a bypass graft procedure using a vein to connect the femoral artery to the popliteal artery in a patient with peripheral vascular disease.
10. A vascular surgeon performing a bypass graft procedure using a vein to connect the femoral artery to the popliteal artery in a patient with atherosclerosis.