How To Use CPT Code 35621

CPT 35621 describes a bypass graft procedure using a synthetic graft to bypass a blockage in the lower aorta or iliac artery by connecting the axillary artery to the femoral artery. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 35621?

CPT 35621 is a code used to describe a bypass graft procedure in which a synthetic graft is used to create a bypass around a blockage in the lower aorta or iliac artery. The procedure involves connecting the axillary artery to the femoral artery to restore blood flow to the lower extremities. This code is used when the provider performs the procedure using a synthetic graft.

2. Official Description

The official description of CPT code 35621 is: ‘Bypass graft, with other than vein; axillary-femoral.’

3. Procedure

1. The provider begins by making an incision near the collarbone to access the axillary artery.
2. Next, the provider makes an incision in the thigh to access the femoral artery.
3. The provider then clears tissue between the axillary artery and the femoral artery, creating a tunnel between the two sites.
4. A synthetic graft is prepared and one end is attached to the axillary artery.
5. The other end of the graft is attached to the femoral artery, creating a bypass around the blockage.
6. The provider may use an end-to-end or end-to-side connection to create the bypass.
7. Once the procedure is complete, the provider closes the incisions in layers.

4. Qualifying circumstances

CPT 35621 is used for patients who have a blockage in the lower aorta or iliac artery that requires a bypass graft procedure. The procedure is performed by a provider using a synthetic graft to create the bypass. The patient must meet the medical necessity criteria for the procedure, which is determined by the provider based on the patient’s condition and symptoms.

5. When to use CPT code 35621

CPT code 35621 should be used when a provider performs a bypass graft procedure using a synthetic graft to bypass a blockage in the lower aorta or iliac artery. This code should not be used if a vein graft is used instead of a synthetic graft. It is important to accurately document the procedure and use the appropriate CPT code to ensure proper reimbursement.

6. Documentation requirements

To support a claim for CPT code 35621, the provider must document the following information:

• Patient’s diagnosis and the medical necessity for the bypass graft procedure
• Details of the procedure, including the use of a synthetic graft and the connection between the axillary artery and the femoral artery
• Date of the procedure
• Any additional procedures or interventions performed during the same operative session
• Any complications or unexpected findings during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 35621, it is important to ensure that the procedure meets the criteria for medical necessity and that the documentation supports the use of a synthetic graft. The procedure should be accurately coded and billed with the appropriate modifiers, if applicable. It is also important to follow any specific billing guidelines provided by the payer to ensure proper reimbursement.

8. Historical information

CPT code 35621 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare reimbursement purposes.

9. Examples

1. A provider performs a bypass graft procedure using a synthetic graft to bypass a blockage in the lower aorta for a patient with peripheral arterial disease.
2. A patient with iliac artery stenosis undergoes a bypass graft procedure using a synthetic graft to restore blood flow to the lower extremities.
3. A provider performs a bypass graft procedure using a synthetic graft to bypass a blockage in the iliac artery for a patient with atherosclerosis.
4. A patient with chronic limb ischemia undergoes a bypass graft procedure using a synthetic graft to improve blood flow to the affected limb.
5. A provider performs a bypass graft procedure using a synthetic graft to bypass a blockage in the lower aorta for a patient with a history of smoking and peripheral vascular disease.
6. A patient with atherosclerosis in the iliac artery undergoes a bypass graft procedure using a synthetic graft to restore blood flow to the legs.
7. A provider performs a bypass graft procedure using a synthetic graft to bypass a blockage in the lower aorta for a patient with diabetes and peripheral arterial disease.
8. A patient with iliac artery occlusion undergoes a bypass graft procedure using a synthetic graft to improve blood flow to the lower extremities.
9. A provider performs a bypass graft procedure using a synthetic graft to bypass a blockage in the iliac artery for a patient with claudication.
10. A patient with atherosclerosis in the lower aorta undergoes a bypass graft procedure using a synthetic graft to restore blood flow to the legs.