How To Use CPT Code 35585

CPT 35585 describes the procedure for an in-situ vein bypass, specifically from the femoral artery to the anterior tibial, posterior tibial, or peroneal artery. 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 35585?

CPT 35585 can be used to describe the creation of an in-situ vein bypass from the femoral artery to the anterior tibial, posterior tibial, or peroneal artery. This procedure is performed to restore blood circulation to the lower extremities by using the patient’s saphenous vein to bypass a blockage in the artery.

2. Official Description

The official description of CPT code 35585 is: ‘In-situ vein bypass; femoral-anterior tibial, posterior tibial, or peroneal artery.’

3. Procedure

1. The provider begins by making an incision in the groin to access the femoral artery.
2. They then expose the saphenofemoral junction and divide any necessary branches.
3. An incision is made over the chosen artery (anterior tibial, posterior tibial, or peroneal) and the soft tissue is dissected to expose the artery.
4. The provider clears the soft tissue around the saphenous vein and ties off any vein branches.
5. The saphenous vein is divided at its ends, leaving most of it in its bed.
6. The provider flushes the vein, disrupts valves if necessary, tests for leaks, and repairs any that are found.
7. Clamps are applied at the first anastomosis site and the saphenous vein conduit is connected to the femoral artery in an end-to-end or end-to-side manner.
8. The same steps are repeated at the second anastomosis site in the anterior, posterior tibial, or peroneal artery.
9. Once the procedure is complete, all clamps and instrumentation are removed, bleeding is checked, and the incisions are closed in layers.

4. Qualifying circumstances

CPT 35585 is performed on patients who require an in-situ vein bypass to restore blood circulation to the lower extremities. The procedure is typically done when there is a blockage in the femoral artery and the patient’s saphenous vein can be used as a conduit for the bypass. The specific qualifying circumstances may vary depending on the patient’s condition and the provider’s clinical judgment.

5. When to use CPT code 35585

CPT code 35585 should be used when the provider performs an in-situ vein bypass from the femoral artery to the anterior tibial, posterior tibial, or peroneal artery. This code is appropriate when the procedure is done to restore blood circulation to the lower extremities using the patient’s saphenous vein as a conduit.

6. Documentation requirements

To support a claim for CPT 35585, the provider must document the following information:

• Patient’s diagnosis and the need for an in-situ vein bypass
• Specific arteries involved in the bypass (anterior tibial, posterior tibial, or peroneal)
• Details of the procedure, including incisions made, vein manipulation, anastomosis sites, and closure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 35585, ensure that the procedure meets the criteria for an in-situ vein bypass from the femoral artery to the anterior tibial, posterior tibial, or peroneal artery. It is important to follow the specific documentation requirements and guidelines provided by the payer. Additionally, consider any applicable modifiers or additional codes that may need to be reported based on the specific circumstances of the procedure.

8. Historical information

CPT 35585 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone changes over the years, including being added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A provider performs an in-situ vein bypass from the femoral artery to the anterior tibial artery to restore blood circulation in a patient with peripheral arterial disease.
2. During a surgical procedure, a provider creates an in-situ vein bypass from the femoral artery to the posterior tibial artery to bypass a blockage and improve blood flow in a patient with critical limb ischemia.
3. A patient with peripheral artery occlusive disease undergoes an in-situ vein bypass from the femoral artery to the peroneal artery to restore blood circulation and alleviate symptoms.
4. A provider performs an in-situ vein bypass from the femoral artery to the anterior tibial artery to improve blood flow and prevent amputation in a patient with diabetic foot ulcers.
5. During a surgical intervention, a provider creates an in-situ vein bypass from the femoral artery to the posterior tibial artery to bypass a blockage and restore blood circulation in a patient with peripheral vascular disease.
6. A patient with chronic limb-threatening ischemia undergoes an in-situ vein bypass from the femoral artery to the peroneal artery to improve blood flow and promote wound healing.
7. A provider performs an in-situ vein bypass from the femoral artery to the anterior tibial artery to restore blood circulation and alleviate symptoms in a patient with peripheral arterial occlusive disease.
8. During a surgical procedure, a provider creates an in-situ vein bypass from the femoral artery to the posterior tibial artery to bypass a blockage and improve blood flow in a patient with critical limb ischemia.