CPT 35535 Hepatic-to-Renal Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35535: Hepatic-to-Renal Artery Bypass with Vein Graft

CPT code 35535 denotes an open vascular bypass procedure connecting the hepatic artery to a portion of the renal artery using a vein graft to circumvent an arterial obstruction. This code captures a complex, operative revascularization technique used in select vascular and transplant-related surgical contexts. Nationally, procedures coded with 35535 are clinically significant due to their association with high-acuity hospital-based care, resource intensity, and the need for multidisciplinary perioperative management.

Key payers relevant to coverage and reimbursement assessments include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of clinical context, common sites of service, and the procedural intent of the code. The publication also outlines what analysts typically examine when benchmarking this code: utilization patterns, hospital inpatient resource use, and payer policy variations.

The report provides: (1) clinical context for when a hepatic-to-renal arterial bypass with a vein graft is performed, (2) expected site-of-service and resource implications, and (3) areas for payers and health system analysts to consider when evaluating claims and coverage policies. Data not provided in the input—such as specific utilization rates, associated taxonomies, ICD-10 pairings, or related codes—are noted as unavailable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35535vascular surgerybypass grafthepatic arteryrenal arteryvein graftinpatient surgeryoperative revascularization

Billing Code Overview

CPT code 35535 describes a surgical vascular bypass procedure in which the provider bypasses a blood vessel blockage by inserting a bypass graft that connects the hepatic artery to a portion of the renal artery using a vein graft. This is a vascular bypass graft operation involving arterial reconstruction using autologous vein conduit.

Service type: Open vascular surgical bypass grafting
Typical site of service: Hospital operating room or inpatient surgical suite

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 62-year-old male with long-standing atherosclerotic peripheral arterial disease and symptomatic renal ischemia due to an occlusive lesion at the origin of the renal artery that is not amenable to endovascular angioplasty or stenting. The patient presents with worsening uncontrolled hypertension, declining renal function, and flank pain. Preoperative workup includes cross-sectional imaging (CT angiography or MR angiography) demonstrating a focal proximal renal artery occlusion with suitable recipient renal artery and a nearby hepatic artery suitable for inflow. The vascular surgery team obtains informed consent and coordinates perioperative anesthesia assessment, blood type and screen, and renal function optimization.

In the operating room under general anesthesia, the surgeon gains abdominal access (open laparotomy or retroperitoneal approach), harvests an autologous vein graft (commonly the greater saphenous vein), and constructs a bypass graft from the hepatic artery to a branch or portion of the renal artery to revascularize the kidney. Intraoperative measures include systemic anticoagulation, hemodynamic monitoring, and assessment of graft patency using Doppler ultrasound or intraoperative angiography. Postoperatively the patient is monitored in a surgical step-down or intensive care setting for graft function, hemodynamics, and renal output; antiplatelet or anticoagulant therapy is managed per vascular surgery protocol. Discharge planning includes wound care, blood pressure control, renal function follow-up, and surveillance imaging to assess graft patency.

Coding Specifications

Modifier	Description	When to Use

CPT 35500: Upper-Extremity Vein Harvest for Bypass Conduit

CPT-35526-AORTO-SUBCLAVIAN-INNOMINATE-CAROTID-VEIN-BYPASS

CPT 35526: Aorto-Subclavian/Innominate/Carotid Vein Bypass

CPT-35537-AORTO-ILIAC-BYPASS-VEIN-GRAFT

CPT 35537: Aorto‑iliac Bypass with Vein Graft

CPT-35515-SUBCLAVIAN-TO-VERTEBRAL-ARTERY-BYPASS-VEIN-GRAFT

CPT 35515: Subclavian-to-Vertebral Artery Bypass with Vein Graft

CPT-35509-CAROTID-TO-CAROTID-VEIN-BYPASS-GRAFT

CPT 35509: Carotid-to-Carotid Bypass with Vein Graft

CPT-35570-TIBIAL-PERONEAL-ARTERY-BYPASS

CPT 35570: Tibial and Peroneal Artery Bypass Procedures

CPT-35506-CAROTID-TO-SUBCLAVIAN-BYPASS-GRAFT

CPT 35506: Carotid-to-Subclavian Bypass Graft

CPT-35572-FEMOROPOPLITEAL-VEIN-HARVEST-FOR-VASCULAR-RECONSTRUCTION

CPT 35572: Femoropopliteal Vein Harvest for Vascular Reconstruction

CPT-35508-CAROTID-TO-VERTEBRAL-BYPASS-GRAFT

CPT 35508: Carotid-to-Vertebral Artery Bypass Graft

CPT-35540-AORTO-BIFEMORAL-VEIN-BYPASS-GRAFT

CPT 35540: Aorto‑bifemoral Vein Bypass Graft

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Taxonomy Code	Specialty	Notes
204N00000X	Vascular Surgery	Primary specialty performing complex arterial bypass procedures.
207K00000X	General Surgery	General surgeons with vascular experience may perform visceral-renal bypass.
2080P0002X	Transplant Surgery	Surgeons experienced in complex visceral vascular reconstruction and renal preservation.
207L00000X	Thoracic Surgery	Thoracic/vascular surgeons involved when thoracoabdominal approach or hepatic inflow is required.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.1`	Atherosclerosis of native arteries of the extremities	Atherosclerotic disease is a common systemic process; renal artery atherosclerosis may necessitate bypass when occlusive.
`I70.2`	Atherosclerosis of native arteries of the extremities with intermittent claudication	Reflects systemic peripheral atherosclerosis often present in patients requiring complex arterial bypass.
`I72.9`	Arterial aneurysm, unspecified	Aneurysmal disease of visceral or renal arteries can complicate anatomy and prompt bypass solutions.
`I77.1`	Stricture of artery	Renal artery stricture or stenosis causing renal ischemia may be an indication for bypass.
`N28.9`	Disease of kidney, unspecified	Declining renal function from chronic ischemia supports revascularization indications.
`I10`	Essential (primary) hypertension	Severe, refractory hypertension related to renal artery occlusion is a common clinical driver for renal revascularization.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35091`	Exposure of artery, with preparation for bypass grafting; renal artery	Prepares and exposes the renal artery for bypass graft anastomosis when separate from the bypass code.
`35631`	Bypass graft, with vein; femoral to popliteal, single segment, above knee	Example of autologous vein bypass technique; related as a comparable conduit-harvest and anastomosis technique.
`35800`	Arterial revision, repair or thrombectomy, without reanastomosis or reimplantation, open	May be performed postoperatively for graft thrombosis or revision of the bypass.
`36247`	Transcatheter placement of intravascular stent(s), with angioplasty when performed; renal arteries, unilateral	Endovascular alternative or adjunct for renal artery revascularization; may be performed before or after open bypass in hybrid cases.
`37720`	Ligation, division, or bypass of iliac artery	Related major arterial bypass procedures demonstrating similar operative planning and postoperative care.

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