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The procedure described by CPT® Code 35694 involves the surgical transposition and/or reimplantation of the subclavian artery to the carotid artery. This complex vascular surgery is performed to alter the normal pathway of blood flow between these two major arteries, which can be necessary for various medical conditions that affect blood circulation. The procedure typically begins with a supraclavicular incision made at the base of the neck, allowing the surgeon access to the subclavian and carotid arteries. During the operation, the clavicular head is incised, and the scalene fat pad is mobilized and reflected superiorly to expose the underlying structures. The thoracic duct may be preserved or ligated, depending on the specific circumstances of the surgery. The phrenic nerve, which is crucial for diaphragm function, is identified and protected throughout the procedure to prevent complications. The anterior scalene muscle is transected to facilitate access to the arteries. The subclavian artery is then carefully dissected free from surrounding tissues, and its branches are divided and ligated to ensure a clear surgical field. Following this, the carotid artery is also exposed and dissected. The vagus nerve, which plays a significant role in autonomic control of the heart and digestive tract, is similarly identified and protected. A tunnel is created posterior to the jugular vein to facilitate the repositioning of the subclavian artery. Systemic anticoagulation is administered intravenously to minimize the risk of thromboembolic events during the procedure. The subclavian artery is divided, and the proximal stump is oversewn. The artery is then pulled through the tunnel, bringing it into proximity with the carotid artery for anastomosis. The carotid artery is incised, and the end of the subclavian artery is sutured to the side of the carotid artery, completing the transposition. This intricate procedure requires a high level of surgical skill and precision to ensure proper blood flow and minimize complications.
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The procedure described by CPT® Code 35694 is indicated for specific vascular conditions that necessitate the alteration of blood flow between the subclavian and carotid arteries. The following are common indications for performing this procedure:
The procedure for CPT® Code 35694 involves several detailed steps to ensure successful transposition and/or reimplantation of the subclavian artery to the carotid artery. The following outlines the procedural steps:
After the completion of the procedure, patients are typically monitored for any complications related to the surgery. Post-procedure care may include managing pain, monitoring for signs of infection, and ensuring proper blood flow to the affected areas. Patients may require follow-up imaging studies to assess the success of the anastomosis and the overall vascular health. Additionally, anticoagulation therapy may be continued to prevent thromboembolic events. The expected recovery time can vary based on the individual patient's health status and the complexity of the procedure.
| Short Descr | ART TRNSPOSJ SUBCLAV CAROTID | Medium Descr | TRPOS&/RIMPLTJ SUBCLAVIAN CAROTID ART | Long Descr | Transposition and/or reimplantation; subclavian 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 |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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. | 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. | 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.) | 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) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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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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