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A bypass graft is a surgical procedure designed to create an alternative pathway for blood flow around a diseased or obstructed segment of the common carotid artery, specifically directing blood to the ipsilateral internal carotid artery. This procedure utilizes a vein, which can be harvested from the patient or obtained from a donor, to form the graft. The surgery is performed through an incision in the neck, allowing the surgeon to access the common carotid artery directly. Once the artery is exposed, clamps are applied to control blood flow and isolate the affected area. The surgeon may choose to tie off the artery above the obstruction to ensure that blood is redirected through the newly created graft. One end of the harvested vein is then meticulously sutured to the common carotid artery, establishing a connection that will facilitate blood flow. After securing the graft, a vessel clamp is placed on the venous graft while the arterial clamp is released, allowing the surgeon to check for any leaks at the anastomosis site. Following this, the internal carotid artery is also exposed and clamped distal to the graft site. The other end of the vein graft is then sutured into the internal carotid artery, and the site is again inspected for leaks and patency. Once confirmed, the neck incision is closed, completing the procedure. This surgical intervention is critical for restoring adequate blood flow to the brain, thereby reducing the risk of stroke and other complications associated with carotid artery disease.
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The bypass graft procedure using CPT® Code 35501 is indicated for patients who present with specific conditions affecting the carotid arteries. These indications include:
The procedure for performing a bypass graft with vein from the common carotid to the ipsilateral internal carotid artery involves several critical steps:
After the bypass graft procedure, patients typically require monitoring for any complications, such as bleeding or infection at the incision site. Recovery may involve a hospital stay for observation, during which vital signs and neurological status are closely monitored. Patients may also be prescribed medications to manage blood pressure and prevent blood clots. Follow-up appointments are essential to assess the success of the graft and ensure that blood flow to the brain is adequate. Rehabilitation may be recommended to help patients regain strength and function, particularly if they experienced a stroke or TIA prior to the procedure. Overall, the post-procedure care is crucial for optimizing recovery and minimizing the risk of future cardiovascular events.
| Short Descr | ART BYP GRFT IPSILAT CAROTID | Medium Descr | BYPASS W/VEIN COMMON-IPSILATERAL CAROTID | Long Descr | Bypass graft, with vein; common carotid-ipsilateral internal carotid | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 56 - Other vascular bypass and shunt, not heart |
This is a primary code that can be used with these additional add-on codes.
| 35572 | Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Harvest of femoropopliteal vein, 1 segment, for vascular reconstruction procedure (eg, aortic, vena caval, coronary, peripheral artery) (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 2007-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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