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CPT 35686: Creation of Arteriovenous Fistula During Lower Extremity Bypass

CPT code 35686 represents the intraoperative creation of an arteriovenous fistula at or beyond the bypass site in a lower extremity performed at the same time as a lower extremity bypass. This code captures a specific vascular surgical adjunct procedure that can affect operative complexity, resource utilization, and postoperative vascular outcomes. It is nationally relevant for hospitals, vascular surgery practices, and payers because it pertains to coding specificity for combined procedures and may influence surgical reimbursement and quality reporting.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, expected sites of service, and how the code is classified within the CPT system. The publication outlines common billing modifiers associated with surgical procedures (Data not available in the input), typical payer considerations (Data not available in the input), and related coding practice points (Data not available in the input).

This summary provides the clinical and coding baseline needed to understand where CPT code 35686 fits in vascular surgery coding, what services it denotes, and what national stakeholders typically consider when managing combined lower extremity bypass and fistula-creation procedures.

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Billing Code Overview

CPT code 35686 describes the creation of a fistula — an abnormal connection formed between an artery and a vein — at or beyond the bypass site in a lower extremity. The procedure is performed by the provider concurrently with a lower extremity bypass operation.

Service type: Surgical vascular procedure performed as an adjunct to lower extremity bypass
Typical site of service: Inpatient or outpatient hospital operating room during lower extremity vascular bypass surgery

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CPT 35686: Creation of Arteriovenous Fistula During Lower Extremity Bypass

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Billing Code Overview

Service type: Surgical vascular procedure performed as an adjunct to lower extremity bypass
Typical site of service: Inpatient or outpatient hospital operating room during lower extremity vascular bypass surgery

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with peripheral arterial disease undergoing a lower extremity arterial bypass to revascularize a critically ischemic limb. During the bypass procedure the vascular surgeon creates an arteriovenous fistula at or distal to the bypass site to improve distal runoff and graft patency. The patient is taken to the operating room under general anesthesia. The vascular surgery team performs arterial exposure, harvests or prepares the bypass conduit, completes the bypass anastomoses, and then performs the simultaneous creation of an arteriovenous fistula between a suitable artery and adjacent vein in the lower extremity. Hemostasis is obtained, wounds closed, and the patient is recovered in the post-anesthesia care unit with vascular monitoring of graft and fistula flow.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	When no specific modifier applies to the service.
`11`	Professional component	When reporting only the professional component of a service (rare for operative codes).
`22`	Increased procedural services	When work required is substantially greater than typically required.
`52`	Reduced services	When the service is partially reduced or not completed as described.
`53`	Discontinued procedure	When the procedure is started but halted due to extenuating circumstances.
`62`	Two surgeons	When two surgeons work together as primary surgeons during the procedure.
`66`	Surgical team	When a surgical team (multiple qualified surgeons) performs the procedure.
`78`	Unplanned return to the operating room following initial procedure for a related procedure during the postoperative period	When the patient returns to the OR for a related issue during global period.
`80`	Assistant surgeon	When an assistant surgeon performs part of the operation.
`81`	Minimum assistant surgeon	When a minimal assistant role is documented.
`82`	Assistant surgeon (unqualified resident)	When an unqualified resident acts as assistant under regulatory allowance.
`LT`	Left side	When the procedure is performed on the left lower extremity.
`RT`	Right side (not in provided list)	Data not available in the input.
`QX`	Modifier certifying CRNA services with anesthesiologist absent	When a CRNA furnishes anesthesia without medical direction by an anesthesiologist.
`QY`	Medical direction of one certified registered nurse anesthetist by an anesthesiologist	When an anesthesiologist medically directs CRNA care.

Taxonomy Code	Specialty	Notes
2080P0206X	Vascular Surgery	Surgeons who perform arterial bypass and fistula creation.
2080P0205X	Cardiothoracic & Vascular Surgery	Vascular procedures within combined specialty practices.
207R00000X	General Surgery	General surgeons with vascular expertise who perform lower extremity bypass.
2084P0800X	Interventional Cardiology	Rarely involved; consults or hybrid procedures may include interventionalists.
2086S0122X	Surgical Critical Care	Perioperative management of complex vascular surgery patients.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.2`	Atherosclerosis of native arteries of the extremities	Common indication for lower extremity bypass and adjunctive fistula to improve runoff.
`I70.21`	Atherosclerosis of native arteries of the extremities with intermittent claudication	Symptomatic PAD leading to revascularization procedures.
`I70.23`	Atherosclerosis of native arteries of the extremities with gangrene	Severe ischemia indication for bypass and adjunctive procedures.
`I74.3`	Embolism and thrombosis of arteries of lower extremity	May necessitate bypass and adjunctive strategies to restore flow.
`I96`	Gangrene, not elsewhere classified	Advanced ischemic tissue loss prompting revascularization.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35686`	Creation of arteriovenous fistula at or beyond bypass site in lower extremity, performed at same time as bypass	Primary code describing creation of an AV fistula performed concurrently with lower extremity arterial bypass.
`35566`	Lower extremity arterial bypass, femoral to below-knee popliteal with vein graft (example)	Common bypass procedure during which `35686` may be performed concurrently to improve runoff.
`35631`	Lower extremity arterial bypass, open; femoral to popliteal, single segment prosthetic or vein graft	Another bypass variant commonly performed before or with fistula creation to enhance outflow.
`35266`	Ligation, open, of arteriovenous fistula (hypothetical related procedure)	Performed if later ligation of the fistula is required due to complications or high-output issues.
`93925`	Duplex scan of extremity arteries and veins (bilateral)	Preoperative or postoperative vascular imaging to evaluate graft and fistula patency.

CPT 35685: Distal Synthetic Patch/Cuff for Bypass Graft

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	When no specific modifier applies to the service.
`11`	Professional component	When reporting only the professional component of a service (rare for operative codes).
`22`	Increased procedural services	When work required is substantially greater than typically required.
`52`	Reduced services	When the service is partially reduced or not completed as described.
`53`	Discontinued procedure	When the procedure is started but halted due to extenuating circumstances.
`62`	Two surgeons	When two surgeons work together as primary surgeons during the procedure.
`66`	Surgical team	When a surgical team (multiple qualified surgeons) performs the procedure.
`78`	Unplanned return to the operating room following initial procedure for a related procedure during the postoperative period	When the patient returns to the OR for a related issue during global period.
`80`	Assistant surgeon	When an assistant surgeon performs part of the operation.
`81`	Minimum assistant surgeon	When a minimal assistant role is documented.
`82`	Assistant surgeon (unqualified resident)	When an unqualified resident acts as assistant under regulatory allowance.
`LT`	Left side	When the procedure is performed on the left lower extremity.
`RT`	Right side (not in provided list)	Data not available in the input.
`QX`	Modifier certifying CRNA services with anesthesiologist absent	When a CRNA furnishes anesthesia without medical direction by an anesthesiologist.
`QY`	Medical direction of one certified registered nurse anesthetist by an anesthesiologist	When an anesthesiologist medically directs CRNA care.

Taxonomy Code	Specialty	Notes
2080P0206X	Vascular Surgery	Surgeons who perform arterial bypass and fistula creation.
2080P0205X	Cardiothoracic & Vascular Surgery	Vascular procedures within combined specialty practices.
207R00000X	General Surgery	General surgeons with vascular expertise who perform lower extremity bypass.
2084P0800X	Interventional Cardiology	Rarely involved; consults or hybrid procedures may include interventionalists.
2086S0122X	Surgical Critical Care	Perioperative management of complex vascular surgery patients.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.2`	Atherosclerosis of native arteries of the extremities	Common indication for lower extremity bypass and adjunctive fistula to improve runoff.
`I70.21`	Atherosclerosis of native arteries of the extremities with intermittent claudication	Symptomatic PAD leading to revascularization procedures.
`I70.23`	Atherosclerosis of native arteries of the extremities with gangrene	Severe ischemia indication for bypass and adjunctive procedures.
`I74.3`	Embolism and thrombosis of arteries of lower extremity	May necessitate bypass and adjunctive strategies to restore flow.
`I96`	Gangrene, not elsewhere classified	Advanced ischemic tissue loss prompting revascularization.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35686`	Creation of arteriovenous fistula at or beyond bypass site in lower extremity, performed at same time as bypass	Primary code describing creation of an AV fistula performed concurrently with lower extremity arterial bypass.
`35566`	Lower extremity arterial bypass, femoral to below-knee popliteal with vein graft (example)	Common bypass procedure during which `35686` may be performed concurrently to improve runoff.
`35631`	Lower extremity arterial bypass, open; femoral to popliteal, single segment prosthetic or vein graft	Another bypass variant commonly performed before or with fistula creation to enhance outflow.
`35266`	Ligation, open, of arteriovenous fistula (hypothetical related procedure)	Performed if later ligation of the fistula is required due to complications or high-output issues.
`93925`	Duplex scan of extremity arteries and veins (bilateral)	Preoperative or postoperative vascular imaging to evaluate graft and fistula patency.

CPT 35685: Distal Synthetic Patch/Cuff for Bypass Graft

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 35686: Creation of Arteriovenous Fistula During Lower Extremity Bypass

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Billing Code Overview

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CPT 35686: Creation of Arteriovenous Fistula During Lower Extremity Bypass

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References