CPT 35632 Iliac-to-Celiac Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35632: Iliac-to-Celiac Synthetic Graft Bypass

CPT code 35632 represents an open vascular bypass in which a synthetic graft is used to reroute flow from the iliac artery around an occluded celiac artery. This procedure addresses significant mesenteric or foregut ischemia caused by celiac trunk obstruction and is a specialized vascular surgery performed in hospital operating rooms or major ambulatory surgical centers. Nationally, CPT 35632 is relevant for tertiary vascular centers and programs managing complex visceral arterial disease because it involves major arterial reconstruction and impacts resource use, perioperative risk stratification, and post-operative monitoring.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes clinical context for the procedure, payer coverage patterns where available, and coding considerations relevant to hospital billing and surgical services. Readers will learn the clinical indication and service setting for CPT 35632, typical billing and documentation touchpoints, common modifiers listed in payer materials, and what information is not available in the input. This overview is intended for coding professionals, billing managers, and clinical leaders seeking a concise reference to the procedure represented by CPT 35632 and its role in managing celiac artery occlusion.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35632CPTvascular-surgeryceliac-artery-bypasssynthetic-graftopen-bypassmesenteric-ischemiahospital-surgery

Billing Code Overview

CPT code 35632 describes a surgical bypass using a synthetic graft to reroute blood flow from the iliac artery around an occluded segment of the celiac artery. The procedure restores perfusion to the foregut circulation by creating an alternative arterial conduit.

Service type: Open vascular bypass using synthetic graft

Typical site of service: Hospital operating room or major ambulatory surgical center for vascular surgery, where open arterial reconstruction and graft placement are performed.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a history of peripheral arterial disease, tobacco use, and chronic mesenteric ischemia presents with postprandial abdominal pain, unintentional weight loss, and failure to thrive. Imaging with CT angiography demonstrates high-grade stenosis or occlusion of the celiac artery with inadequate collateral flow. After multidisciplinary evaluation, the vascular surgeon elects to perform an open extra-anatomic bypass using a synthetic graft from the common or external iliac artery to the celiac artery to restore antegrade mesenteric perfusion.

The clinical workflow includes preoperative assessment with cardiac and pulmonary clearance, vascular imaging review, informed consent, intraoperative exposure of the iliac artery and celiac artery via laparotomy or retroperitoneal approach, anastomosis of a prosthetic graft to bypass the obstructed segment, verification of graft patency with Doppler or completion angiography, hemostasis, and postoperative monitoring in a step-down or intensive care setting with antiplatelet therapy and surveillance imaging as indicated.

Coding Specifications

Modifier	Description	When to Use
`00`	Default/No modifier	Used when no other modifier applies to the service.
`11`

CPT 35600: Arterial Graft Harvest from Arm for Coronary Bypass

CPT-35602-CAROTID-TO-CAROTID-PROSTHETIC-ARTERIAL-BYPASS

CPT 35602: Carotid-to-Carotid Bypass Using Prosthetic Graft

CPT-35631-AORTO-VISCERAL-RENAL-BYPASS-SYNTHETIC-GRAFT

CPT 35631: Aortic-to-Visceral/Renal Bypass with Synthetic Graft

CPT-35647-AORTO-FEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35647: Aorto-Femoral Bypass with Synthetic Graft

CPT-35663-ILIAC-ARTERY-CROSS-FEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35663: Iliac Artery Cross-Femoral Bypass with Synthetic Graft

CPT-35621-AXILLOFEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35621: Axillofemoral Bypass Using Synthetic Graft

CPT-35634-ILIAC-TO-RENAL-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35634: Iliac-to-Renal Artery Bypass Using Synthetic Graft

CPT-35671-POPLITEAL-TO-TIBIAL-PERONEAL-BYPASS-SYNTHETIC-GRAFT

CPT 35671: Popliteal to Tibial/Peroneal Bypass with Synthetic Graft

CPT-35638-AORTO-BILATERAL-ILIAC-BYPASS-SYNTHETIC-GRAFT

CPT 35638: Aorto to Bilateral Iliac Bypass with Synthetic Graft

CPT-35656-FEMORAL-TO-POPLITEAL-BYPASS-SYNTHETIC-GRAFT

CPT 35656: Femoral-to-Popliteal Bypass with Synthetic Graft

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Taxonomy Code	Specialty	Notes
207RG0100X	Vascular Surgery	Primary specialty performing open arterial bypass procedures.
2080P0207X	General Surgery	General surgeons with vascular expertise may perform mesenteric bypass in some centers.
2084P0800X	Cardiothoracic-Vascular Surgery	Surgeons trained in thoracoabdominal vascular procedures that include visceral revascularization.
2085R0203X	Interventional Radiology	Provides preoperative or intraoperative angiography and endovascular alternatives; not typically performing open bypass.
207K00000X	Physician Assistant	APPs commonly assist perioperatively and may be reported with appropriate assistant modifiers.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I77.4`	Stricture of artery	Represents focal arterial narrowing that may necessitate bypass when endovascular options are unsuitable.
`I70.2`	Atherosclerosis of native arteries of the extremities (nonvisceral)	Atherosclerotic disease commonly coexists and indicates systemic atherosclerosis; relevant to graft planning and graft conduit selection.
`K55.1`	Chronic mesenteric ischemia	Primary clinical indication for celiac revascularization when symptomatic and due to occlusive disease.
`I74.3`	Embolism and thrombosis of arteries of the lower extremity (visceral emboli codes less specific)	Thrombotic or embolic occlusion of visceral arteries may prompt bypass if acute or chronic and unsuitable for endovascular therapy.
`K76.9`	Liver disease, unspecified	Included to represent potential hepatic ischemia risk when celiac perfusion is compromised; may affect surgical risk assessment.
`Z95.2`	Presence of prosthetic heart valve	Example of comorbidity that may influence perioperative anticoagulation planning (illustrative comorbidity).

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35632`	Bypass graft, with other than venous conduit, from iliac artery to celiac artery; with synthetic graft	Primary procedure: open extra-anatomic bypass using a synthetic graft to revascularize the celiac artery.
`36245`	Selective catheter placement, celiac trunk, with angiography	Often performed preoperatively or intraoperatively to define celiac anatomy and confirm distal runoff.
`36147`	Introduction of needle and/or catheter for diagnostic angiography, visceral artery	Used for diagnostic visceral angiography when assessing mesenteric circulation preoperatively.
`75952`	Percutaneous transluminal angioplasty, percutaneous, including radiological supervision and interpretation; each vessel	May be attempted as an endovascular alternative or adjunct to open bypass when anatomy permits.
`34820`	Repair, arterial, with prosthetic graft, with direct anastomosis to visceral artery (example code for complex arterial reconstruction)	Represents related arterial reconstruction techniques that may be performed when visceral branches require direct repair or bypass; used in intraoperative decision-making.
`93975`	Duplex scan of abdominal vessels (lack of a single definitive CPT for mesenteric duplex)	Noninvasive surveillance study used pre- and postoperatively to assess graft patency and mesenteric flow.

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