Rules of the Bypass

Sloan Medical

Professional Medical Management specializing in Vascular Surgery.

Vascular Surgery April 5, 2020

Code Sections

Bypass Graft with Vein · 35501-35571

In-Situ Vein Bypass · 35583-35587

Bypass Graft with Other Than Vein · 35601-35671 Adjuvant Techniques · 35685-35686 Harvesting/Composite Grafts · 33508-35683

Coder Tips In-Situ vein bypass- using the patients own vein for bypass without excising the vein. The vein is kept in its native bed with mobilization at both ends.

Common Mistakes Made When Coding Lower Extremity Bypass Grafts

· All inflow and out flow procedures as well as endarterectomies done in the location of the bypass are included in the bypass CPT codes.

Please Note- reporting endarterectomies with bypass that clearly document the endarterectomy was done in a separate vessel from the origin or termination point of the bypass is ok. Most commonly reported is a bypass that includes the femoral artery and a thromboendarterectomy of the common femoral or deep (profunda) femoral. Reporting the thromboendarterectomy of the common femoral would not be acceptable however if documentation supports a significantly separate endarterectomy of the profunda was completed this would be considered a separate vessel and is billable. Documentation must specify the endarterectomy was done to a significant length within the profunda and not just part of transitioning/smoothing of plaque into the profunda.

· Use the add-on code 35400 - angioscopy (noncoronary vessels or grafts) during therapeutic intervention, when performed. Must be listed in addition to primary procedure code.

· Angiograms are included in the work of a bypass and should not be billed separately unless the below criteria are met.

Please Note- If a patient has not had a recent diagnostic angiogram or there is documentation that the patient has had a clinical change and needs a new diagnostic angiogram then you are able to bill for the angiogram with the bypass.

· Harvesting of the saphenous vein for a vein bypass or in-situ bypass is included and not separately billable.

Please Note- you may bill for the harvest of an upper extremity vein (35500) or the femoropopliteal vein (35572). Do not report 35600/33508 with lower extremity bypass grafts, they are assigned to coronary bypass procedures.

· If an aortobifemoral graft with vein is performed use CPT 35540. CPT code 35539 describes a unilateral aortofemoral procedure and should not be used to describe a bilateral aortobifemoral procedure.

· CPT code 34813- Placement of femoral- femoral prosthetic graft during endovascular aortic aneurysm repair- should only be used for bypass during and endovascular repair of an aneurysm.

· Use CPT 35700 for reoperation more than one month after original operation. This CPT should be used in addition to the CPT for the primary procedure.

CPT Terminology

Femoral includes the common, superficial and deep (profunda) femoral artery.

Ilio/Iliac includes the common, external or internal iliac artery.

Popliteal includes the above- knee, behind- knee or below- knee popliteal artery.

Tibial includes the anterior tibial, posterior tibial, plantar, tibioperoneal trunk, dorsalis pedis or tarsal- peroneal is not included in this section.

Questions asked will be answered

1. What work is included in the preparation/anastomosis of the patient’s vein for “with vein” bypass?

a. All inflow and outflow work.

b. Rendering the valves incompetent.

c. Includes harvest and preparation of the saphenous vein for the same or opposite leg.

d. Orientating the vein (reversed or orthograde)

e. Angiography- unless diagnostic angiography was not done prior to procedure or patients’ clinical status has changed and provider documents new angiography is needed.

2. Why are lower extremity bypass surgeries performed?

a. Loss of pulse in legs or feet

b. Inadequate blood flow to lower extremities causing non-healing wounds or ulcer.

c. Peripheral vascular disease with gangrene, claudication, rest pain or other complications.

d. Cold limb.

e. Ischemic rest pain.

Sloan Medical LLC

Revenue Cycle Management for Vascular and General Surgery

Overland Park KS

66213

913-634-3837

Alex.nedzelskiy@sloanmed.com