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The procedure described by CPT® Code 35695 involves the surgical transposition and/or reimplantation of the carotid artery to the subclavian artery. This complex vascular surgery is typically performed to address specific anatomical or pathological conditions that may necessitate the rerouting of blood flow between these two major arteries. The procedure begins with a supraclavicular incision 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. Care is taken to identify and protect critical anatomical components, such as the phrenic nerve and the vagus nerve, which are essential for maintaining normal physiological function. The surgical steps involve meticulous dissection of the arteries to ensure that they are free from surrounding tissues, which is crucial for the success of the anastomosis. The procedure may also involve the preservation or ligation of the thoracic duct, depending on the specific circumstances encountered during surgery. The creation of a tunnel behind the sternocleidomastoid muscle and jugular vein facilitates the repositioning of the arteries. The use of systemic anticoagulants is standard practice to prevent thromboembolic complications during the procedure. Ultimately, the end of the carotid artery is sutured to the side of the subclavian artery, establishing a new pathway for blood flow. This procedure is critical in managing conditions that affect blood supply and can significantly impact patient outcomes.
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The procedure described by CPT® Code 35695 is indicated for specific clinical scenarios where there is a need to reroute blood flow from the carotid artery to the subclavian artery. The following conditions may warrant this surgical intervention:
The procedure for CPT® Code 35695 involves several critical steps to ensure successful transposition and/or reimplantation of the carotid artery to the subclavian artery. The following procedural steps are performed:
After the completion of the procedure, patients are typically monitored for any signs of complications, such as bleeding or infection. Post-operative care may include the administration of anticoagulants to prevent thromboembolic events, as well as pain management strategies to ensure patient comfort. Patients may also require follow-up imaging studies to assess the patency of the newly established arterial connections. Recovery time can vary based on individual patient factors and the complexity of the procedure, but close monitoring and follow-up are essential to ensure optimal outcomes.
| Short Descr | ART TRNSPOSJ CAROTID SUBCLAV | Medium Descr | TRPOS&/RIMPLTJ CAROTID SUBCLAVIAN ART | Long Descr | Transposition and/or reimplantation; carotid 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. | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 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). | 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) | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | 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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