Summary & Overview
CPT 35879: Lower Extremity Bypass Graft Repair with Venous Patch
CPT code 35879 represents a vascular surgical procedure to open a lower extremity arterial bypass graft and apply a venous patch to enlarge a narrowed area. Nationally, this code signals interventions to salvage or improve patency of lower limb bypass grafts, which has implications for limb preservation, surgical quality measures, and payer coverage policies. The procedure is commonly performed in hospital operating rooms or ambulatory surgical centers by vascular surgeons.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for graft revision with venous patching, the typical settings where the service is delivered, and the primary considerations payers evaluate when processing claims for this service. The publication outlines commonly observed billing modifiers, related procedural groupings, and typical claims pathways used by payers. It also highlights benchmarking points and policy considerations relevant to reimbursement and utilization review.
The content provides practical reference material for coding, clinical documentation, and payer discussions, as well as a baseline for institutional benchmarking. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 35879 describes a surgical procedure in which the provider opens a lower extremity arterial bypass graft and applies a venous patch to widen a narrowed segment. This service involves revision or repair of an existing arterial bypass graft in the leg and is focused on restoring adequate blood flow through the grafted vessel.
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Service type: Surgical vascular graft revision/patch angioplasty
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Typical site of service: Hospital operating room or ambulatory surgical center for vascular surgery
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a history of peripheral arterial disease who previously received a lower extremity arterial bypass graft (e.g., femoropopliteal or femorotibial) and now presents with graft stenosis producing recurrent claudication, rest pain, or threatened limb ischemia. The patient undergoes preoperative evaluation including vascular imaging (duplex ultrasound, CT angiography, or conventional angiography) confirming a focal, surgically amenable narrowing of the venous bypass graft. The clinical workflow begins with preoperative cardiopulmonary assessment, consent, and antibiotic prophylaxis per institutional protocol. In the operating room or vascular suite under general, regional, or monitored anesthesia care, the surgeon exposes the graft, clamps proximal and distal segments, opens the graft at the narrowed segment, excises any scar or intimal hyperplasia as needed, and applies a venous patch (autologous vein patch) to widen the lumen and restore flow. Immediate intraoperative assessment of flow (clinical assessment, Doppler signals, or completion angiography) is performed. Postoperative care includes limb perfusion monitoring, anticoagulation or antiplatelet management, wound care, and follow-up vascular imaging and clinic visits to assess graft patency and limb function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Modifier not typically used for claims; placeholder | Data not applicable for clinical use |