General Surgery Coding Alert

Answer: Coding these procedures can be simplified by answering two questions, says Ellen North, CPC, CPC-H, senior consultant/manager, Ambulatory Coding and Reimbursement, Intermountain Healthcare, a multispecialty practice in Salt Lake City.

1. Is the bypass graft a vein (35500-35571), in-situ vein (35582-35587), or other than a vein (35601-35671)?

2. From which vessel and to which vessel is the graft being made?

In this specific example, an externally supported PTFE (polytetrafluoroethylene) graft is a synthetic man-made graft. This is not a vein or in-situ vein, so the choice of codes is narrowed down to 35601-35671. Second, the graft is attached to the common femoral artery of the unaffected leg and tunneled below the skin of the lower abdomen to the other legs common femoral artery below the blocked area. This creates the detour or bypass and allows blood flow to the affected leg. Code 35661 (bypass graft, with other than vein; femoral-femoral) should be selected.

Other possible options for a femoral bypass include 35656 (bypass graft, with other than vein; femoral-popliteal) and 35646 (bypass graft, with other than vein; aortofemoral or bifemoral).

Atherosclerosis is the building up of plaque and subsequent narrowing of the arteries. When the arteries are blocked, the extremities do not receive the required blood flow. Pain and weakness result from this lack of blood flow, which clinically is referred to as ischemia. Bypass surgeries restore the blood flow by going around the blockage, just as a detour goes around a construction site.