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An in-situ vein bypass is a surgical procedure that utilizes the saphenous vein to create a bypass around occluded arteries in the lower extremities, specifically targeting the femoral-anterior tibial, femoral-posterior tibial, or femoral-peroneal arteries. This technique is employed when there is a blockage in these arteries that impedes blood flow, potentially leading to complications such as pain, ulcers, or limb ischemia. The procedure begins with an incision in the leg to expose the saphenous vein, which is then carefully evaluated for its suitability as a bypass conduit. The proximal and distal segments of the vein are mobilized while preserving the majority of the vein in its original location. The saphenous vein is subsequently ligated and divided at the saphenofemoral junction, ensuring a cuff of femoral vein is included for optimal anastomosis. The vein is then connected to the common femoral, proximal superficial femoral, or popliteal artery, allowing arterial blood to flow through the vein after the venous valves are rendered incompetent using a valvulotome. This step is crucial as it facilitates the unidirectional flow of arterial blood through the saphenous vein. Following this, tributaries of the saphenous vein are identified and ligated to prevent complications. The distal end of the saphenous vein is also ligated and divided before being anastomosed to the appropriate artery, such as the popliteal, anterior tibial, posterior tibial, or peroneal artery. After completing the anastomoses, vascular clamps are released, and hemostasis is meticulously checked at all anastomosis sites. Finally, the success of the bypass is confirmed by assessing blood flow using Doppler ultrasound and evaluating distal pulses to ensure the patency of the newly created in-situ bypass.
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The in-situ vein bypass procedure is indicated for patients experiencing occlusion in the lower extremity arteries, specifically the femoral-anterior tibial, femoral-posterior tibial, or femoral-peroneal arteries. This condition may present with various symptoms and complications, including:
The in-situ vein bypass procedure involves several critical steps to ensure successful bypass of the occluded arteries:
Post-procedure care for patients undergoing an in-situ vein bypass includes monitoring for any signs of complications, such as bleeding or infection at the incision site. Patients are typically advised to rest and limit physical activity for a specified period to promote healing. Follow-up appointments are essential to assess the success of the bypass, which may include Doppler studies to evaluate blood flow and ensure the patency of the anastomoses. Patients may also receive education on lifestyle modifications, including smoking cessation and dietary changes, to improve overall vascular health and prevent future occlusions.
| Short Descr | VEIN BYP FEM-TIBIAL PERONEAL | Medium Descr | IN-SITU FEM-ANT TIBL PST TIBL/PRONEAL ART | Long Descr | In-situ vein bypass; femoral-anterior tibial, posterior tibial, or peroneal 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 | 2 | 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) |
| LT | Left side (used to identify procedures performed on the left side of the body) | 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). | RT | Right side (used to identify procedures performed on the right 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. | 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. | 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). | AG | Primary physician | 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 | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | 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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