How To Use CPT Code 35650

CPT 35650 describes a bypass graft procedure using a synthetic graft to reroute blood flow around a blockage in the axillary 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 35650?

CPT 35650 is used to describe a bypass graft procedure in which a synthetic graft is used to create a new pathway for blood flow in the axillary artery. This procedure is performed to bypass a blockage or narrowing in the artery, allowing blood to flow smoothly and avoid the clotted area.

2. Official Description

The official description of CPT code 35650 is: ‘Bypass graft, with other than vein; axillary-axillary.’

3. Procedure

1. The provider makes an incision over the axillary arteries and prepares the synthetic graft.
2. Clamps are applied to the axillary artery to temporarily stop blood flow.
3. The provider creates an opening on either side of the clamps and sutures one end of the synthetic graft to one side of the axillary artery.
4. The graft is then passed around the blockage and sutured to the other side of the axillary artery.
5. Alternatively, the provider may incise the axillary artery and connect the end of the synthetic graft to the end of the axillary artery, passing the graft through a tunnel created under the skin.
6. An opening is made in the other side of the axillary artery and the graft is attached in an end-to-side or side-to-side manner.
7. The clamps are released and the provider checks for any leaks.
8. The patency of the graft may be checked using arteriography or an ultrasound probe.
9. The incision is closed in layers and a drain may be placed if necessary.

4. Qualifying circumstances

CPT 35650 is performed on patients with a blockage or severe narrowing in the axillary artery that requires a bypass graft. The procedure is typically performed by a vascular surgeon or other qualified provider. The use of a synthetic graft is necessary for this procedure.

5. When to use CPT code 35650

CPT code 35650 should be used when a bypass graft procedure is performed using a synthetic graft to reroute blood flow in the axillary artery. This code is specific to the axillary-axillary bypass graft procedure and should not be used for other types of bypass grafts or vein grafts.

6. Documentation requirements

To support a claim for CPT 35650, the provider must document the following information:

• Patient’s diagnosis and the need for a bypass graft procedure
• Details of the procedure, including the use of a synthetic graft and the specific approach (axillary-axillary)
• Date of the procedure
• Any additional procedures performed during the same session
• Any complications or unexpected findings
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 35650, ensure that the procedure meets the criteria for this specific code. It is important to accurately document the use of a synthetic graft and the axillary-axillary approach. CPT code 35650 should not be reported with other codes unless additional procedures were performed during the same session.

8. Historical information

CPT code 35650 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.

9. Examples

1. A vascular surgeon performs an axillary-axillary bypass graft procedure using a synthetic graft to bypass a blockage in the axillary artery.
2. A patient with a severe narrowing in the axillary artery undergoes an axillary-axillary bypass graft procedure to restore proper blood flow.
3. A synthetic graft is used to create a new pathway for blood flow in the axillary artery during an axillary-axillary bypass graft procedure.
4. A vascular specialist performs an axillary-axillary bypass graft procedure to bypass a blockage in the axillary artery and improve blood flow.
5. An axillary-axillary bypass graft procedure is performed using a synthetic graft to reroute blood flow and bypass a blockage in the axillary artery.
6. A patient with a blocked axillary artery undergoes an axillary-axillary bypass graft procedure to restore blood flow and prevent further complications.
7. A vascular surgeon performs an axillary-axillary bypass graft procedure using a synthetic graft to bypass a severe narrowing in the axillary artery.
8. An axillary-axillary bypass graft procedure is performed to bypass a blockage in the axillary artery and improve blood flow to the arm.
9. A synthetic graft is used to create a new pathway for blood flow in the axillary artery during an axillary-axillary bypass graft procedure.
10. A patient with limited blood flow in the axillary artery undergoes an axillary-axillary bypass graft procedure to restore proper circulation.