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The procedure described by CPT® Code 35661 refers to a bypass graft performed using a synthetic material rather than a vein, specifically a femoral-femoral bypass. This surgical intervention is typically indicated for patients with significant arterial occlusion or stenosis that impairs blood flow in the lower extremities. The procedure involves making incisions in the groin area on both sides, allowing access to the common femoral arteries. Surgeons meticulously dissect the soft tissue to expose these arteries, which are critical for blood supply to the legs. An abdominal tunnel is then created to facilitate the placement of a cross-over graft, which connects one femoral artery to the other, effectively bypassing the obstructed segment. A tubular synthetic graft is selected based on the patient's anatomy and prepared for implantation. The procedure requires clamping of the common femoral artery on the unobstructed side, followed by incision and suturing of the graft to this artery. The graft is then passed through the tunnel to the contralateral femoral artery, which is also clamped and incised for graft attachment. After securing the grafts, vascular clamps are removed, and the surgeon checks for blood flow through the graft using Doppler ultrasound, while also evaluating distal pulses to confirm the patency of the bypass graft. This detailed approach ensures that the graft functions properly, restoring adequate blood circulation to the affected leg.
© Copyright 2025 Coding Ahead. All rights reserved.
The femoral-femoral bypass graft procedure, as described by CPT® Code 35661, is indicated for patients experiencing significant arterial occlusion or stenosis that compromises blood flow to the lower extremities. This condition may manifest as claudication, rest pain, or critical limb ischemia, necessitating surgical intervention to restore adequate perfusion. The procedure is particularly relevant for individuals who may not be suitable candidates for other forms of revascularization, such as endovascular techniques or vein grafting, due to the specific anatomical or pathological circumstances of their vascular disease.
The femoral-femoral bypass graft procedure involves several critical steps to ensure successful grafting and restoration of blood flow. Initially, Step 1: incisions are made bilaterally in the groin area over the common femoral arteries. This access point is essential for the subsequent dissection and exposure of the arteries. Step 2: the surgeon carefully dissects the soft tissue surrounding the common femoral arteries to fully expose them, allowing for precise surgical manipulation. Step 3: an abdominal tunnel is created, which serves as a pathway for the cross-over graft that will connect the two femoral arteries. Step 4: a tubular synthetic graft is selected based on the patient's specific anatomical requirements and prepared for implantation. Step 5: the common femoral artery on the unobstructed side is then clamped to prevent blood flow, followed by an incision made in the artery. The cross-over graft is then sutured securely to this artery. Step 6: the graft is passed through the previously created tunnel to reach the contralateral femoral artery. Step 7: the contralateral femoral artery is clamped and incised, allowing for the graft to be sutured to this artery as well. Step 8: once both ends of the graft are secured, the vascular clamps are removed, and the final step involves checking blood flow through the graft using Doppler ultrasound. The surgeon also evaluates distal pulses to ensure that the bypass graft is patent and functioning correctly, confirming that adequate blood flow has been restored to the lower extremities.
After the completion of the femoral-femoral bypass graft procedure, patients are typically monitored closely for any signs of complications, such as bleeding or graft failure. Post-operative care includes managing pain and ensuring that the surgical site is healing properly. Patients may be advised to engage in gradual mobilization to promote circulation and prevent complications such as deep vein thrombosis. Follow-up appointments are essential to assess the patency of the graft and monitor the patient's recovery progress. Additionally, patients may receive education on lifestyle modifications and medication management to support vascular health and prevent future arterial occlusions.
| Short Descr | ART BYP FEMORAL-FEMORAL | Medium Descr | BYP OTH/THN VEIN FEMORAL-FEMORAL | Long Descr | Bypass graft, with other than vein; femoral-femoral | 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 |
| LT | Left side (used to identify procedures performed on the left side of the body) | 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 | 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. | 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). | 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). | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | 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 | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | ET | Emergency services | GW | Service not related to the hospice patient's terminal condition | 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. |