How To Use CPT Code 35587

CPT 35587 describes the procedure for in-situ vein bypass, specifically the popliteal-tibial and peroneal arteries. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 35587?

CPT 35587 can be used to describe the in-situ vein bypass procedure performed by a healthcare provider. This procedure involves creating a bypass using the patient’s saphenous vein to restore blood circulation to the lower extremities. The provider accesses the popliteal artery behind the knee and connects the saphenous vein conduit to the popliteal or tibial artery, bypassing any blockages in the peroneal artery.

2. Official Description

The official description of CPT code 35587 is: ‘In-situ vein bypass; popliteal-tibial, peroneal.’

3. Procedure

1. The healthcare provider makes incisions behind the knee to access the popliteal artery and over the tibial or peroneal artery.
2. The provider exposes the saphenous vein, dividing branches as necessary, and clears soft tissue from around the vein.
3. Vein branches are tied off, and the saphenous vein is divided at its ends, leaving most of it in its bed.
4. The provider flushes the vein, disrupts valves if needed, tests for leaks, and repairs any found.
5. Clamps are applied at the anastomosis sites, and the saphenous vein conduit is connected to the popliteal or tibial artery.
6. The same steps are repeated at the second anastomosis site in the peroneal artery.
7. After removing clamps and instrumentation, the provider checks for bleeding and closes the incisions in layers.

4. Qualifying circumstances

CPT 35587 is performed on patients with blockages in the peroneal artery who require restoration of blood circulation to the lower extremities. The procedure is typically performed by a healthcare provider who is experienced in performing in-situ vein bypass procedures. The patient’s condition must warrant the need for this specific bypass procedure, and the provider must determine that the saphenous vein is suitable for use as a conduit.

5. When to use CPT code 35587

CPT code 35587 should be used when a healthcare provider performs an in-situ vein bypass procedure specifically involving the popliteal-tibial and peroneal arteries. This code is appropriate when the provider uses the patient’s saphenous vein as a conduit to bypass blockages in these arteries and restore blood circulation to the lower extremities.

6. Documentation requirements

To support a claim for CPT 35587, the healthcare provider must document the following information:

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

7. Billing guidelines

When billing for CPT 35587, ensure that the procedure performed matches the description of the code. The provider should document the specific arteries involved in the bypass procedure. It is important to note that CPT 35587 is an inpatient-only procedure, meaning it should not be reported for outpatient services. Additionally, if the provider performs multiple bypass procedures at different sites of obstruction during the same encounter, appropriate anatomic modifiers or modifier 59 should be used to indicate the distinct procedural services.

8. Historical information

CPT 35587 was added to the Current Procedural Terminology system on January 1, 1990. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A healthcare provider performs an in-situ vein bypass procedure on a patient with a blockage in the peroneal artery, using the patient’s saphenous vein to restore blood circulation to the lower extremities.
2. During an in-situ vein bypass procedure, a provider connects the saphenous vein conduit to the popliteal artery to bypass a blockage in the peroneal artery.
3. A patient undergoes an in-situ vein bypass procedure, where the provider uses the patient’s saphenous vein to create a bypass between the popliteal and peroneal arteries.
4. A healthcare provider performs an in-situ vein bypass procedure on a patient with peripheral arterial disease, using the patient’s saphenous vein to bypass a blockage in the peroneal artery.
5. During an in-situ vein bypass procedure, the provider connects the saphenous vein conduit to the tibial artery to bypass a blockage in the peroneal artery.
6. A patient undergoes an in-situ vein bypass procedure, where the provider uses the patient’s saphenous vein to create a bypass between the popliteal and tibial arteries.
7. A healthcare provider performs an in-situ vein bypass procedure on a patient with critical limb ischemia, using the patient’s saphenous vein to bypass a blockage in the peroneal artery.
8. During an in-situ vein bypass procedure, the provider connects the saphenous vein conduit to the peroneal artery to bypass a blockage in the popliteal-tibial arteries.
9. A patient undergoes an in-situ vein bypass procedure, where the provider uses the patient’s saphenous vein to create a bypass between the popliteal and peroneal arteries.