© Copyright 2025 American Medical Association. All rights reserved.
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. This technique is particularly important for restoring blood flow in cases where arteries are blocked, which can lead to serious complications such as limb ischemia. During the procedure, an incision is made in the leg to expose the saphenous vein, which is then carefully evaluated for its suitability. The proximal and distal ends of the vein are mobilized while leaving the majority of the vein intact. The procedure involves ligating and dividing the saphenous vein at the saphenofemoral junction, ensuring that a cuff of femoral vein is preserved for the anastomosis. The saphenous vein is subsequently connected to the common femoral, proximal superficial femoral, or popliteal artery, allowing arterial blood to flow through the vein after the venous valves are destroyed using a valvulotome. This destruction of the valves is crucial as it prevents backflow and facilitates proper blood circulation. The distal end of the saphenous vein is then ligated and divided, followed by anastomosis to the popliteal, anterior tibial, posterior tibial, or peroneal artery. Throughout the procedure, vascular clamps are used to control blood flow, and hemostasis is meticulously checked at all anastomosis sites. Finally, Doppler ultrasound is employed to confirm blood flow and evaluate distal pulses, ensuring the success and patency of the in-situ bypass.
© Copyright 2025 Coding Ahead. All rights reserved.
The in-situ vein bypass procedure is indicated for patients with occluded lower extremity arteries, particularly when there is a need to restore blood flow to the affected areas. The following conditions may warrant this surgical intervention:
The in-situ vein bypass procedure involves several critical steps to ensure successful bypass of the occluded arteries. The following procedural steps are performed:
After the in-situ vein bypass procedure, patients are monitored for any signs of complications, such as bleeding or infection. Expected recovery includes a period of rest and gradual mobilization to promote healing. Follow-up appointments are essential to assess the success of the bypass and ensure that blood flow is adequately restored. Patients may also undergo Doppler studies to evaluate the patency of the bypass graft. It is important for patients to adhere to any prescribed rehabilitation protocols and lifestyle modifications to support vascular health and prevent future occlusions.
| Short Descr | VEIN BYP POP-TIBL PERONEAL | Medium Descr | IN-SITU VEIN BYP POP-TIBL PRONEAL | Long Descr | In-situ vein bypass; popliteal-tibial, peroneal | 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) |
| 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. | 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). | 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 | 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) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2013-01-01 | Changed | Short Descriptor changed. |
| Pre-1990 | Added | Code added. |
Get instant expert-level medical coding assistance.