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Official Description

Repair blood vessel with graft other than vein; lower extremity

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 35286 involves the surgical repair of a blood vessel located in the lower extremity using a graft that is not derived from a vein. This type of intervention is typically indicated when there is significant damage to a blood vessel, which may occur due to trauma, disease, or other pathological conditions. The repair process is critical for restoring proper blood flow to the affected area, thereby preventing complications such as ischemia or tissue necrosis. The surgical approach is determined by the specific blood vessel that has sustained injury, which may include arteries or other vascular structures in the leg. During the procedure, the surgeon carefully exposes the injured vessel and employs clamps to control bleeding by occluding blood flow both proximal and distal to the site of injury. In some cases, a temporary shunt may be placed to maintain perfusion to the limb while the repair is being performed. The surgeon assesses the extent of the injury to determine the most appropriate type of graft to use, which may involve harvesting a segment of artery or utilizing a synthetic graft material. The repair involves meticulous debridement of the damaged vessel edges and precise suturing of the graft to the vessel ends, followed by the removal of the temporary shunt and thorough checks for hemostasis. Finally, the surrounding tissues are sutured back together in layers to ensure proper healing and restoration of the anatomical structure.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure associated with CPT® Code 35286 is indicated for the repair of a blood vessel in the lower extremity when there is significant injury or damage that necessitates surgical intervention. The following conditions may warrant this procedure:

  • Trauma: Injury to the lower extremity blood vessels due to accidents, falls, or penetrating injuries.
  • Vascular Disease: Conditions such as atherosclerosis or thrombosis that lead to compromised blood flow and require surgical repair.
  • Congenital Anomalies: Structural abnormalities in blood vessels present at birth that may require correction.

2. Procedure

The surgical procedure for CPT® Code 35286 involves several critical steps to ensure effective repair of the injured blood vessel:

  • Step 1: The surgeon begins by making an incision to expose the injured blood vessel in the lower extremity. This exposure is crucial for accessing the site of injury and allows for a clear view of the damaged area.
  • Step 2: Once the vessel is exposed, clamps are applied both proximal and distal to the injury. This clamping is essential to control bleeding during the repair process by temporarily stopping blood flow to the affected segment.
  • Step 3: To maintain blood flow to the limb while the repair is being performed, a temporary shunt may be placed. This shunt allows for perfusion of blood around the injured area, minimizing the risk of ischemia.
  • Step 4: The surgeon evaluates the extent of the injury to determine the appropriate type of graft needed for the repair. If an arterial graft is selected, a segment of artery is harvested from another site in the body and prepared for grafting. Alternatively, a synthetic graft may be chosen based on the specific requirements of the repair.
  • Step 5: The edges of the injured blood vessel are carefully debrided to remove any damaged tissue. This step is vital for ensuring a clean surface for the graft to adhere to.
  • Step 6: The prepared arterial or synthetic graft is then sutured to the proximal and distal ends of the injured blood vessel. This connection restores continuity and allows for normal blood flow through the graft.
  • Step 7: After the graft is securely in place, the temporary shunt is removed, and the clamps are released. The surgeon checks for hemostasis along the suture line to ensure that there is no bleeding from the repair site.
  • Step 8: Finally, the overlying tissues are sutured back together in layers, ensuring proper anatomical alignment and promoting optimal healing.

3. Post-Procedure

Post-procedure care following the repair of a blood vessel with grafting involves monitoring the surgical site for signs of infection, ensuring proper blood flow to the lower extremity, and managing pain. Patients may be advised to limit physical activity during the initial recovery phase to promote healing. Follow-up appointments are essential to assess the success of the graft and to monitor for any potential complications, such as graft failure or thrombosis. The healthcare team will provide specific instructions regarding wound care, medication management, and any necessary lifestyle modifications to support recovery.

Short Descr RPR BLVSL GRF OTH/TH VN LXTR
Medium Descr RPR BLVSL W/GRF OTHER/THAN VEIN LOWER EXTREMITY
Long Descr Repair blood vessel with graft other than vein; lower extremity
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 Hospital Part B services paid through a comprehensive APC
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P2F - Major procedure, cardiovascular-Other
MUE 2
CCS Clinical Classification 61 - Other OR procedures on vessels other than head and neck
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.
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).
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.)
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.
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
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.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
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.)
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
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
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)
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
XP Separate practitioner, a service that is distinct because it was performed by a different practitioner
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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2025-01-01 Changed Short Description changed.
Pre-1990 Added Code added.
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