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The procedure described by CPT® Code 35693 involves the surgical transposition and/or reimplantation of the vertebral artery to the subclavian artery. This complex vascular surgery is performed to address issues related to the vertebral artery, which may include redundancy or other anatomical variations that necessitate repositioning for improved blood flow. The procedure begins with an incision in the neck to expose the vertebral artery, allowing the surgeon to assess its length and condition. A systemic anticoagulant is administered intravenously to prevent clotting during the procedure. The surgeon then identifies the appropriate site on the subclavian artery for anastomosis, which is the surgical connection between the two blood vessels. The redundant portion of the vertebral artery is carefully clamped and divided above any stenosis or occlusion, ensuring that the healthy segment can be effectively reimplanted. The vertebral artery is then brought into proximity with the subclavian artery, where it is anastomosed in an end-to-side fashion. This meticulous process is crucial for restoring adequate blood flow, and prior to closing the incision, the vessels are backbled to ensure proper circulation is re-established. This procedure is essential for patients who may experience compromised blood flow due to anatomical variations or vascular conditions affecting the vertebral artery and its connection to the subclavian artery.
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The procedure described by CPT® Code 35693 is indicated for patients who present with specific vascular conditions that may necessitate the transposition and/or reimplantation of the vertebral artery to the subclavian artery. These indications may include:
The procedure for CPT® Code 35693 involves several critical steps to ensure successful transposition and reimplantation of the vertebral artery to the subclavian artery. The steps are as follows:
After the completion of the procedure, patients are typically monitored for any signs of complications, such as bleeding or infection at the surgical site. Recovery may involve a period of observation in a hospital setting, where vital signs and neurological status are closely assessed. Patients may be advised on activity restrictions and follow-up appointments to ensure proper healing and function of the newly established vascular connections. The overall goal of the post-procedure care is to ensure that blood flow is adequately restored and that the patient can return to normal activities safely.
| Short Descr | ART TRNSPOSJ SUBCLAVIAN | Medium Descr | TRPOS&/RIMPLTJ VERTEBRAL SUBCLAVIAN ART | Long Descr | Transposition and/or reimplantation; vertebral to subclavian 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 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). | 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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