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The procedure described by CPT® Code 35691 involves the surgical transposition and/or reimplantation of the vertebral artery to the carotid artery. This complex vascular surgery is performed to address specific conditions affecting blood flow in the vertebral artery, which is a critical vessel supplying blood to the posterior part of the brain. The procedure begins with the physician making an incision in the neck to expose the vertebral artery, allowing for direct access to the vessel. A systemic anticoagulant is administered intravenously to prevent clotting during the procedure. The surgeon then assesses the available length of the vertebral artery to determine the feasibility of the anastomosis, which is the surgical connection between two vessels. In this procedure, the anastomosis site on the common carotid artery is carefully marked to ensure precise alignment during the connection. The vertebral artery is clamped just below the longus colli muscle, and a ligature is placed at its origin. The artery is then transected above the ligature, allowing it to be maneuvered through the surrounding anatomical structures, specifically the cervical sympathetic ganglia, to reach the planned anastomosis site. The actual connection is performed in an end-to-side fashion, where the vertebral artery is sutured to the common carotid artery. Before concluding the procedure, the surgeon ensures that blood flow is properly restored by backbleeding the vessels, tying the sutures, and re-establishing blood flow first to the common carotid artery and subsequently to the vertebral artery. This meticulous approach is essential for ensuring the success of the procedure and the restoration of adequate blood supply to the brain. The procedure is critical for patients with vascular issues that may compromise cerebral perfusion, thereby preventing potential neurological deficits.
© Copyright 2026 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 35691 is indicated for patients experiencing specific vascular conditions that necessitate the transposition and/or reimplantation of the vertebral artery. These indications may include:
The procedure involves several critical steps to ensure successful transposition and/or reimplantation of the vertebral artery. The steps are as follows:
After the completion of the procedure, patients are typically monitored for any complications related to the surgery. Expected recovery may involve a period of observation in a hospital setting to ensure that blood flow is adequately restored and that there are no signs of vascular complications. Follow-up care may include imaging studies to assess the success of the anastomosis and to monitor for any potential issues. Patients may also require rehabilitation to regain strength and function, depending on their overall health and the extent of the vascular condition being treated.
| Short Descr | ART TRNSPOSJ VERTBRL CAROTID | Medium Descr | TRPOS&/RIMPLTJ VERTEBRAL CAROTID ART | Long Descr | Transposition and/or reimplantation; vertebral to carotid artery | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 59 - Other OR procedures on vessels of head and neck |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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