Summary & Overview
CPT 35634: Iliac-to-Renal Artery Bypass Using Synthetic Graft
CPT code 35634 represents a surgical vascular bypass in which a synthetic graft is used to reroute blood flow from the iliac artery around an obstructed renal artery. This procedure restores renal perfusion when direct repair or endovascular therapy is unsuitable. Nationally, 35634 is relevant for vascular surgery, transplant medicine, and nephrology-related care because it addresses renal ischemia with a durable open surgical solution.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of the clinical context for using a synthetic iliac-to-renal bypass, typical sites of service, and the procedural purpose. The publication summarizes what to expect in terms of service classification and coding, and outlines the types of benchmarks and policy items commonly relevant to this procedure, including reimbursement considerations, prior authorization trends, and clinical documentation priorities.
This analysis provides clinicians, coding professionals, and policy stakeholders with a concise reference to the code definition, clinical indications, and how the procedure is positioned in payer and regulatory contexts. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 35634 describes a vascular bypass procedure using a synthetic graft to reroute blood flow from the iliac artery to bypass a blocked segment of the renal artery. The procedure is performed to restore renal perfusion when the native renal artery is obstructed and direct repair is not feasible.
Service Type: Surgical vascular bypass using synthetic graft
Typical Site of Service: Operating room or vascular surgery suite, inpatient or outpatient hospital setting depending on clinical status
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old with long-standing atherosclerotic disease, resistant hypertension, and progressive renal insufficiency due to high-grade ostial renal artery stenosis of the right kidney. After noninvasive imaging (duplex ultrasound, CT angiography) and diagnostic catheter-based angiography confirm a focal, surgically unsuitable lesion at the proximal renal artery that is not amenable to endovascular stenting, the vascular surgery team schedules an open extrarenal bypass. In the operating room under general anesthesia, the surgeon exposes the right common iliac artery and the renal artery, harvests or prepares a synthetic prosthetic graft (e.g., PTFE), and creates a bypass conduit from the iliac artery to the renal artery to re-establish renal perfusion. Typical workflow includes preoperative evaluation (cardiac clearance, laboratory assessment), intraoperative heparinization and vascular control, completion angiography or Doppler assessment of graft patency, and postoperative monitoring in a step-down or intensive care setting for renal function, blood pressure control, and graft surveillance. Typical Site of Service: hospital operating room; typical Service Type: open vascular surgical bypass procedure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no other modifier applies to the submitted service |