Summary & Overview
CPT 35636: Splenic-to-Renal Artery Bypass with Synthetic Graft
CPT code 35636 represents a vascular surgical bypass using a synthetic graft to reroute flow from the splenic artery around a blockage in the renal artery. This procedure is clinically significant for restoring renal perfusion in cases where endovascular or direct repair is not suitable and can impact resource use, operating room time, and postoperative monitoring requirements. Nationally, the code is relevant to academic medical centers, vascular surgery practices, and hospitals managing complex renovascular disease.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, typical sites of service, and the transactional billing context for CPT code 35636. The publication summarizes benchmark considerations, common modifier usage listed in the source data, and implications for claims processing and documentation requirements. It also outlines areas where policy changes or payer-specific coverage rules commonly affect authorization and reimbursement workflows.
The report is intended to inform billing managers, vascular surgery clinicians, and coding professionals about the coding intent, operational impacts, and payer landscape for CPT code 35636 at a national level.
Billing Code Overview
CPT code 35636 describes a surgical bypass procedure in which a synthetic graft is used to reroute blood flow from the splenic artery around an occluded segment of the renal artery. The procedure creates an alternative arterial connection to restore renal perfusion when direct repair or angioplasty is not feasible.
Service Type: Vascular surgical bypass using synthetic graft
Typical Site of Service: Inpatient or ambulatory surgical center; operating room under general anesthesia
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with a history of long-standing hypertension, peripheral arterial disease, and chronic kidney disease presents with progressive, refractory renovascular hypertension and worsening renal function. Duplex ultrasound and CT angiography demonstrate a high-grade ostial stenosis of the right renal artery not amenable to endovascular angioplasty due to severe calcification and anatomic complexity. After multidisciplinary vascular surgery and nephrology evaluation, the patient is scheduled for an open renal artery bypass using a synthetic graft from the splenic artery to the right renal artery to restore renal perfusion.
The clinical workflow includes preoperative optimization (cardiac risk assessment, renal function assessment, medication adjustments), intraoperative steps (general anesthesia, abdominal exposure, identification of splenic artery and right renal artery, construction of a synthetic graft conduit and anastomoses, hemostasis), and postoperative care (ICU monitoring for hemodynamics and renal function, wound care, anticoagulation management as indicated, and follow-up imaging with duplex or CTA to assess graft patency). Typical site of service is an inpatient operating room in a tertiary care hospital or academic medical center.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default — no modifier | Routine reporting when no modifier applies |