Summary & Overview
CPT 35647: Aorto-Femoral Bypass with Synthetic Graft
CPT code 35647 denotes an open vascular bypass procedure using a synthetic graft to reroute blood flow from the lower aorta to a femoral artery, bypassing an aortic obstruction. This procedure is clinically significant for patients with aortoiliac occlusive disease or severe aortic atherosclerotic disease that impairs lower-extremity perfusion. Nationally, such vascular reconstructions remain an important component of surgical management for advanced peripheral arterial disease and carry implications for hospital resource use, perioperative risk management, and long-term limb salvage.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, common claim modifiers and billing considerations, and the typical site-of-service expectations. The publication summarizes benchmarks and payer coverage themes where available, highlights coding and documentation elements relevant to reimbursement and claims processing, and outlines the clinical indications that commonly accompany use of this code. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 35647 describes a surgical procedure in which a provider uses a synthetic graft to bypass an occlusion in the lower aorta by rerouting the connection to a femoral artery around the aortic blockage. The procedure is a form of vascular bypass surgery intended to restore distal blood flow when the infrarenal aorta or aortoiliac segment is obstructed.
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Service type: Open vascular bypass procedure using a synthetic graft
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Typical site of service: Hospital operating room or inpatient surgical unit
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with a history of smoking, hypertension, hyperlipidemia, and peripheral arterial disease presents with progressive bilateral lower extremity claudication and decreased ankle-brachial indices. Imaging with computed tomography angiography demonstrates an atherosclerotic occlusion of the infrarenal abdominal aorta proximal to the common femoral arteries. After multidisciplinary evaluation, the vascular surgery team schedules an open aorto-femoral bypass using a synthetic graft to re-establish direct arterial inflow to the femoral circulation.
Preoperative workflow includes preoperative cardiac risk assessment, informed consent detailing graft selection and potential complications, crossmatch and perioperative antibiotics, and anesthesia evaluation for general anesthesia. Intraoperatively, exposure of the lower abdominal aorta and one or both common femoral arteries is performed; the synthetic graft is anastomosed proximally to the aorta above the occlusion and distally to the femoral artery to bypass the occluded aortic segment. Postoperative care includes monitoring in a step-down or intensive care setting depending on comorbidities, anticoagulation management as indicated, wound care, duplex ultrasound surveillance of graft patency, and physical therapy for ambulation prior to discharge.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | Use when no specific modifier applies and the service is furnished as billed |