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Official Description

Bypass graft, with vein; popliteal-tibial, -peroneal artery or other distal vessels

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 35571 refers to a surgical procedure known as a bypass graft using a vein, specifically targeting the popliteal artery and its branches, including the tibial and peroneal arteries, or other distal vessels. This procedure is typically indicated for patients with significant arterial occlusion or blockage that impairs blood flow to the lower leg and foot. The surgery involves making an incision on the affected side behind the knee to expose the popliteal artery, which is a major blood vessel supplying the lower leg. The procedure entails creating a bypass route for blood flow by using a vein graft, often harvested from the saphenous vein in the leg. The process includes careful dissection and ligation of the vein, followed by anastomosis, which is the surgical connection of the graft to the popliteal artery and the distal artery. This technique is crucial for restoring adequate blood circulation, alleviating symptoms such as pain or claudication, and preventing complications associated with poor blood flow, such as tissue necrosis or limb loss.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 35571 is indicated for patients experiencing significant arterial occlusion or blockage in the lower extremities. The following conditions may warrant this surgical intervention:

  • Peripheral Artery Disease (PAD) - A condition characterized by narrowed arteries reducing blood flow to the limbs, often leading to pain and mobility issues.
  • Critical Limb Ischemia - A severe obstruction of blood flow to the extremities, which can result in pain at rest, non-healing wounds, or gangrene.
  • Claudication - Pain or cramping in the legs or buttocks during physical activities due to inadequate blood flow.
  • Diabetic Foot Ulcers - Non-healing wounds in diabetic patients that may require improved blood supply for healing.

2. Procedure

The procedure for CPT® Code 35571 involves several critical steps to ensure successful bypass grafting. Each step is detailed as follows:

  • Step 1: Incision and Exposure - An incision is made on the affected side behind the knee to access the popliteal artery. This initial step is crucial for visualizing the artery and preparing for the grafting process.
  • Step 2: Distal Anastomosis Site Exposure - The distal anastomosis site, which may include the anterior tibial, posterior tibial, peroneal, or other arteries, is also exposed to facilitate the connection of the graft.
  • Step 3: Tunnel Creation - A tunnel is created from the popliteal artery to the distal anastomosis site. This tunnel serves as the pathway for the vein graft to be placed.
  • Step 4: Vein Graft Harvesting - A vein graft is harvested, typically from the saphenous vein. An incision is made over the section of the saphenous vein to be harvested, followed by dissection of the soft tissue surrounding the vein. Branches of the vein are ligated and divided to prepare for removal.
  • Step 5: Vein Preparation - The section of the saphenous vein intended for use is ligated proximally and distally, then divided and removed from the leg, ensuring it is suitable for grafting.
  • Step 6: Graft Anastomosis - The vein graft is anastomosed to the femoral artery, and then passed through the previously created tunnel to reach the distal anastomosis site.
  • Step 7: Proximal and Distal Anastomosis - The popliteal artery is clamped and incised, allowing the proximal end of the graft to be anastomosed. Similarly, the distal artery is clamped, incised, and the distal end of the graft is anastomosed.
  • Step 8: Hemostasis and Flow Check - After the anastomoses are completed, vascular clamps are released, and hemostasis at all anastomosis sites is checked. Blood flow through the graft is assessed using Doppler ultrasound, and distal pulses are evaluated to ensure the patency of the bypass graft.

3. Post-Procedure

Post-procedure care following the bypass graft involves monitoring the patient for any signs of complications, such as infection or graft failure. Patients are typically observed for adequate blood flow to the lower extremities, and follow-up Doppler studies may be performed to assess graft patency. Pain management and rehabilitation may be initiated to promote recovery and improve mobility. Patients are advised on wound care and signs of potential complications to report to their healthcare provider. The expected recovery period may vary based on individual health factors and the extent of the procedure.

Short Descr ART BYP POP-TIBL-PRL-OTHER
Medium Descr BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL
Long Descr Bypass graft, with vein; popliteal-tibial, -peroneal artery or other distal vessels
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 55 - Peripheral vascular bypass

This is a primary code that can be used with these additional add-on codes.

35500 Addon Code MPFS Status: Active Code APC N CPT Assistant Article Harvest of upper extremity vein, 1 segment, for lower extremity or coronary artery bypass procedure (List separately in addition to code for primary procedure)
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)
35682 Addon Code MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Bypass graft; autogenous composite, 2 segments of veins from 2 locations (List separately in addition to code for primary procedure)
35683 Addon Code MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Bypass graft; autogenous composite, 3 or more segments of vein from 2 or more locations (List separately in addition to code for primary procedure)
35686 Add-on Code MPFS Status: Active Code APC N CPT Assistant Article Illustration for Code Creation of distal arteriovenous fistula during lower extremity bypass surgery (non-hemodialysis) (List separately in addition to code for primary procedure)
35700 Addon Code MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Reoperation, femoral-popliteal or femoral (popliteal)-anterior tibial, posterior tibial, peroneal artery, or other distal vessels, more than 1 month after original operation (List separately in addition to code for primary procedure)
RT Right side (used to identify procedures performed on the right side of the body)
LT Left side (used to identify procedures performed on the left side of the body)
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).
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).
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).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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.
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.
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.)
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
CR Catastrophe/disaster related
GC This service has been performed in part by a resident under the direction of a teaching physician
GW Service not related to the hospice patient's terminal condition
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
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.
Pre-1990 Added Code added.
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