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A carotid-contralateral carotid bypass graft, identified by CPT® Code 35509, is a surgical procedure designed to create a new pathway for blood flow using a vein graft. This procedure is specifically indicated for patients with a diseased or obstructed segment of the carotid artery, which can lead to reduced blood flow to the brain and increase the risk of stroke. The surgery involves making an incision over the common carotid artery on one side of the neck, allowing the surgeon to access and carefully dissect the artery from surrounding tissues. The procedure requires meticulous handling of nearby nerves and veins to minimize complications. The surgeon dissects the carotid artery for a length of approximately 5-6 cm to ensure adequate exposure for the grafting process. A similar dissection is performed on the contralateral carotid artery to facilitate the connection of the vein graft. The use of soft rubber loops helps control blood flow during the procedure, ensuring a safe environment for the creation of a bypass. A vein graft, often harvested from the saphenous vein in the leg, is then used to bypass the obstructed area. The graft is sutured to both the healthy carotid artery and the diseased contralateral carotid artery, restoring blood flow and improving circulation to the brain. The procedure concludes with checks for graft patency using Doppler ultrasound and evaluation of distal pulses, ensuring the success of the bypass graft.
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The carotid-contralateral carotid bypass graft procedure is indicated for patients experiencing specific conditions related to carotid artery disease. These indications include:
The carotid-contralateral carotid bypass graft procedure involves several critical steps to ensure successful grafting and restoration of blood flow. The steps include:
Post-procedure care for patients undergoing a carotid-contralateral carotid bypass graft includes monitoring for any signs of complications, such as bleeding or infection at the incision sites. Patients are typically observed for neurological function to ensure that blood flow to the brain has been successfully restored. Follow-up appointments are essential to assess the graft's patency and overall recovery. Patients may also be prescribed medications to manage blood pressure and prevent blood clots, as well as lifestyle modifications to support cardiovascular health.
| Short Descr | ART BYP GRFT CONTRAL CAROTID | Medium Descr | BYPASS W/VEIN CAROTID-CONTRALATERAL CAROTID | Long Descr | Bypass graft, with vein; carotid-contralateral carotid | 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 | 56 - Other vascular bypass and shunt, not heart |
This is a primary code that can be used with these additional add-on codes.
| 35572 | Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Harvest of femoropopliteal vein, 1 segment, for vascular reconstruction procedure (eg, aortic, vena caval, coronary, peripheral artery) (List separately in addition to code for primary procedure) |
| 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). | 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. | 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 |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 2007-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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