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CPT®
35645

CPT® Code 35645

Official Description

Bypass graft, with other than vein; subclavian-vertebral

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

A bypass graft, specifically coded as CPT® 35645, refers to a surgical procedure that involves creating a bypass around a diseased or obstructed segment of the vertebral artery using a synthetic graft rather than a vein. This procedure is particularly relevant for patients with conditions affecting the vertebral arteries, which are critical for supplying blood to the brainstem, cerebellum, and occipital lobes. The vertebral arteries originate from the brachiocephalic artery on the right side and the subclavian artery on the left side, entering the cervical spine at the C6 transverse process and traveling through the C6-C2 processes before exiting at the base of the skull. The procedure entails making an incision over the vertebral artery below the obstructed area, carefully dissecting the artery from surrounding tissues, and then utilizing a tubular synthetic graft to restore blood flow. The graft is sutured to the vertebral artery after clamping and incising it, ensuring that blood flow is reestablished and monitored for patency post-surgery. This procedure is essential for maintaining adequate cerebral perfusion in patients with vertebral artery obstructions.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The bypass graft procedure coded as CPT® 35645 is indicated for patients experiencing conditions that lead to obstruction or disease of the vertebral artery. These conditions may include:

  • Vertebral Artery Stenosis - A narrowing of the vertebral artery that can impede blood flow to the brain.
  • Vertebral Artery Occlusion - Complete blockage of the vertebral artery, which can result in significant neurological deficits.
  • Trauma - Injury to the vertebral artery that may necessitate surgical intervention to restore blood flow.
  • Atherosclerosis - Buildup of plaque in the vertebral artery leading to reduced blood flow and potential ischemic events.

2. Procedure

The procedure for a subclavian-vertebral bypass graft involves several critical steps to ensure successful graft placement and restoration of blood flow. The steps are as follows:

  • Step 1: Incision - An incision is made below the clavicle to access the subclavian artery. This location is chosen to facilitate the connection between the graft and the artery.
  • Step 2: Exposure of the Subclavian Artery - The subclavian artery is carefully exposed through dissection, ensuring that surrounding tissues are preserved to minimize complications.
  • Step 3: Clamping and Incision of the Artery - Once the artery is adequately exposed, vascular clamps are applied to control blood flow. The subclavian artery is then incised to prepare for the graft placement.
  • Step 4: Graft Preparation - An appropriately sized tubular synthetic graft is selected based on the dimensions of the artery and the specific needs of the patient. The graft is prepared for suturing.
  • Step 5: Suturing the Graft - The synthetic graft is sutured to the incised subclavian artery, ensuring a secure connection that will allow for proper blood flow through the graft.
  • Step 6: Removal of Vascular Clamps - After the graft is securely in place, the vascular clamps are removed to restore blood flow through the newly created bypass.
  • Step 7: Verification of Blood Flow - The blood flow through the graft is checked using Doppler ultrasound, and distal pulses are evaluated to ensure the patency of the bypass graft.

3. Post-Procedure

Post-procedure care for patients undergoing a subclavian-vertebral bypass graft includes monitoring for any signs of complications, such as graft occlusion or infection. Patients are typically observed for changes in neurological status, and follow-up imaging may be performed to assess the integrity and function of the graft. Pain management and rehabilitation may also be part of the recovery process, depending on the individual patient's needs and overall health status.
Short Descr ART BYP SUBCLAV-VERTEBRL
Medium Descr BYP OTH/THN VEIN SUBCLAVIAN-VERTEBRAL
Long Descr Bypass graft, with other than vein; subclavian-vertebral
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
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).
Date
Action
Notes
2013-01-01 Changed Short Descriptor changed.
Pre-1990 Added Code added.
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