CPT 35686 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

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.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35686vascular surgerylower extremity bypassarteriovenous fistulasurgical adjunctoperating roomhospital inpatientprocedure coding

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

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).

CPT 35685: Distal Synthetic Patch/Cuff for Bypass Graft

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.

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