How To Use CPT Code 35693

CPT 35693 describes the procedure of transposition and/or reimplantation of the vertebral artery to the subclavian artery. 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 35693?

CPT 35693 is used to describe a surgical procedure in which the provider fully exposes the vertebral artery and then divides and anastomoses it to the subclavian artery. This procedure is performed to improve arterial blood flow in cases where there is a blockage or narrowing in the vertebral artery.

2. Official Description

The official description of CPT code 35693 is: ‘Transposition and/or reimplantation; vertebral to subclavian artery.’

3. Procedure

1. The provider begins by making an incision above the clavicle area to expose the vertebral and subclavian arteries.
2. With careful precision, the provider fully exposes the arteries while preserving the surrounding structures.
3. The vertebral artery is then divided above the stenosis, and the end of the vessel is occluded or ligated.
4. The provider proceeds to reimplant the healthy portion of the vertebral artery into the subclavian artery, bypassing the blocked area.
5. The arteries are connected in an end-to-side manner, allowing for normal blood flow.
6. To ensure the success of the procedure, the provider may perform an arteriography or use an ultrasound probe to check the patency of the graft.
7. The incisions are closed, and a drain may be placed.

4. Qualifying circumstances

CPT 35693 is performed in cases where there is a blockage or narrowing in the vertebral artery that affects arterial blood flow. This procedure is typically reserved for patients who have not responded to other treatment options. It is important to note that only qualified providers with the necessary expertise should perform this procedure.

5. When to use CPT code 35693

CPT code 35693 should be used when the provider performs the transposition and/or reimplantation of the vertebral artery to the subclavian artery. It is important to accurately document the details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 35693, the provider must document the following information:

• Patient’s diagnosis and the need for the transposition and/or reimplantation procedure
• Details of the procedure, including the incision site, exposure of the arteries, division and anastomosis of the vessels, and closure of the incisions
• Any additional procedures performed, such as arteriography or ultrasound
• Any complications or unexpected findings during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 35693, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately document the details of the procedure to support the use of this code. Additionally, be aware of any specific billing guidelines or modifiers that may be required by payers.

8. Historical information

CPT 35693 was added to the Current Procedural Terminology system on January 1, 1994. In 2017, it was added to the Inpatient Only (IPO) list for Medicare reimbursement purposes.

9. Examples

1. A patient with a blockage in the vertebral artery undergoes a transposition and reimplantation procedure to improve arterial blood flow.
2. A provider performs a transposition and reimplantation of the vertebral artery to the subclavian artery in a patient with a history of recurrent strokes.
3. A surgical team successfully completes a transposition and reimplantation procedure to bypass a blockage in the vertebral artery and restore normal blood flow.
4. A patient with symptoms of vertebrobasilar insufficiency undergoes a transposition and reimplantation procedure to alleviate the condition.
5. A provider performs a transposition and reimplantation of the vertebral artery to the subclavian artery in a patient with a congenital anomaly affecting arterial blood flow.
6. A surgical team performs a transposition and reimplantation procedure to address a blockage in the vertebral artery and prevent further complications.
7. A patient with a history of recurrent TIAs undergoes a transposition and reimplantation procedure to improve blood flow in the vertebral artery.
8. A provider performs a successful transposition and reimplantation of the vertebral artery to the subclavian artery in a patient with symptoms of subclavian steal syndrome.
9. A surgical team performs a transposition and reimplantation procedure to restore normal blood flow in the vertebral artery and prevent future complications.
10. A patient with a blockage in the vertebral artery undergoes a transposition and reimplantation procedure to improve arterial blood flow and reduce the risk of stroke.