Summary & Overview
CPT 35256: Lower Extremity Blood Vessel Repair with Vein Graft
CPT code 35256 represents surgical repair of an abnormal or injured lower extremity blood vessel using a vein graft. This vascular reconstruction procedure restores arterial circulation in the leg by interposing a harvested vein to bypass or repair damaged segments. It is a clinically significant code for hospitals and vascular surgery practices because it captures a major operative intervention with implications for surgical resource use, postoperative care, and payer authorization. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical service captured by the code, typical sites of service, and the common modifiers associated with perioperative billing. The publication also outlines benchmarking context and payer coverage considerations at a national level, plus operational notes relevant to coding teams and revenue cycle leaders. Data not available in the input is noted where applicable, including specific ICD-10 pairings, payer-specific reimbursement amounts, and associated taxonomies. The content provides actionable clarity on what CPT code 35256 denotes, why it matters in coding and billing workflows, and what documentation elements typically support its use.
Billing Code Overview
CPT code 35256 describes surgical repair of an abnormal or injured blood vessel in a lower extremity using a vein graft. This procedure involves harvesting a vein graft and implanting it to restore or bypass compromised arterial flow in the leg.
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Service type: Vascular surgery, graft reconstruction
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Typical site of service: Hospital operating room or inpatient surgical suite
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old male with progressive ischemic rest pain and nonhealing ulceration on the distal lower extremity after peripheral arterial disease and prior atherosclerotic disease. After diagnostic arterial imaging (duplex ultrasound and contrast angiography) demonstrating an occluded segment of the superficial femoral or popliteal artery not amenable to endovascular-only repair, the vascular surgeon plans an open arterial bypass using a reversed autogenous vein graft to restore inflow to the distal limb. The clinical workflow includes preoperative vascular assessment and cardiac risk stratification, informed consent, preoperative labs and anesthesia evaluation, harvest of the greater saphenous vein, arterial exposure and thrombectomy as needed, construction of proximal and distal anastomoses with the vein graft, intraoperative assessment of graft flow, wound closure, and postoperative monitoring in a surgical or monitored bed for limb perfusion, pain control, anticoagulation management, and wound care. Typical hospitalization ranges from same-day observation for uncomplicated cases to several days if comorbidities or wound management require inpatient care. Ambulatory clinics (vascular surgery offices) coordinate pre- and postoperative care; the procedure itself is performed in an operating room or vascular suite under general, regional, or monitored anesthesia care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
RT | Right side | Use when the procedure is performed on the right lower extremity |