Summary & Overview
CPT 35646: Aorto-Femoral Bypass with Synthetic Graft
CPT code 35646 denotes an open aorto-femoral bypass using a synthetic graft to reroute blood flow around an occlusion in the lower abdominal aorta. This procedure is a definitive revascularization technique for significant aortoiliac occlusive disease that threatens limb perfusion or causes disabling claudication. Nationally, the code represents a high-complexity vascular surgery that drives inpatient surgical utilization, resource intensity, and postoperative monitoring needs.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when the procedure is performed, common sites of service, and the implications for surgical resource planning. The publication also summarizes benchmarking elements and policy-relevant considerations such as utilization drivers, typical inpatient care pathways, and coding clarity to support accurate claims submission.
This summary provides hospital and payer leaders, vascular surgeons, and coding professionals with the high-level context needed to interpret utilization and coverage discussions around CPT code 35646. Data not available in the input are noted where specific payer policies, associated taxonomies, and ICD-10 diagnosis pairings would normally be detailed.
Billing Code Overview
CPT code 35646 describes a surgical procedure in which a synthetic graft is used to bypass an obstruction in the lower abdominal aorta by creating a conduit to the femoral arteries around the blocked segment. This aorto-femoral bypass using synthetic graft material restores lower-extremity blood flow when the native aortic segment is not suitable for direct repair.
Service Type: Open vascular bypass surgery
Typical Site of Service: Inpatient operating room / vascular surgery suite, with postoperative inpatient recovery and possible intensive monitoring depending on clinical status and comorbidities.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 65-year-old male with progressive claudication, rest pain, or critical limb ischemia due to an occlusive aortoiliac atherosclerotic lesion. The patient often has risk factors such as smoking, hypertension, diabetes mellitus, and hyperlipidemia. Diagnostic workup includes a vascular history and physical exam, ankle-brachial indices (ABI), duplex ultrasound, and cross-sectional imaging with CT angiography or MR angiography that demonstrate an infrarenal aortic occlusion or severe aortoiliac stenosis not amenable to endovascular repair. The clinical workflow begins with preoperative medical optimization and informed consent, perioperative cardiac and anesthetic evaluation (general or regional anesthesia), and prophylactic antibiotics. In the operating room, the vascular surgeon exposes the infrarenal aorta and bilateral femoral arteries, clamps the aorta, and constructs a synthetic (prosthetic) aortofemoral bypass graft to reroute flow around the diseased aortic segment to the femoral arteries. Intraoperative decisions include graft type/size selection, need for adjunctive endarterectomy or iliac bypass extension, and hemostasis. Postoperative care involves monitoring in a post-anesthesia recovery or intensive care unit, surveillance of pedal pulses, duplex graft surveillance, antiplatelet therapy, and risk-factor modification. Typical site of service is an inpatient operating room for a major vascular procedure, with postoperative inpatient stay for monitoring and rehabilitation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier |