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A bypass graft procedure involving the carotid-subclavian or subclavian-carotid arteries is performed to create an alternative pathway for blood flow around a diseased or obstructed segment of the artery. This surgical intervention utilizes a vein, typically harvested from the patient's leg, to form a graft that connects the carotid artery to the subclavian artery or vice versa. The procedure begins with a supraclavicular incision, which allows the surgeon to access the subclavian artery. During the operation, the scalene fat pad is carefully dissected, and the anterior scalene muscle is divided to facilitate exposure of the arteries. The surgeon then controls blood flow by placing rubber loops around the arteries at the planned incision sites. A vein graft, often a saphenous vein, is harvested from the leg, which involves making an incision over the vein, dissecting the surrounding soft tissue, and ligating any branches before removing the vein segment. Once the graft is prepared, the subclavian artery is clamped and incised, and the vein graft is sutured in place. The carotid artery is also incised or a window is created to attach the graft. After ensuring proper placement, the vascular clamps are removed, and blood flow through the graft is verified using Doppler ultrasound, along with an evaluation of distal pulses to confirm the success of the bypass graft.
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The carotid-subclavian or subclavian-carotid bypass graft procedure is indicated for patients who present with specific vascular conditions that necessitate the creation of an alternative blood flow pathway. The following conditions may warrant this surgical intervention:
The procedure for a carotid-subclavian or subclavian-carotid bypass graft involves several critical steps to ensure successful graft placement and restoration of blood flow. The following outlines the procedural steps:
Post-procedure care for patients undergoing a carotid-subclavian or subclavian-carotid bypass graft includes monitoring for any complications such as bleeding, infection, or graft failure. Patients are typically observed in a recovery area where vital signs are closely monitored. Pain management is provided as needed, and patients may be advised on activity restrictions to promote healing. Follow-up appointments are essential to assess the success of the graft and to monitor for any signs of complications or recurrence of symptoms. Additionally, patients may be prescribed medications to manage risk factors such as hypertension or hyperlipidemia to support long-term vascular health.
| Short Descr | ART BYP GRFT SUBCLAV-CAROTID | Medium Descr | BYPASS W/VEIN CAROTID-SUBCLV/SUBCLAVIAN CAROTID | Long Descr | Bypass graft, with vein; carotid-subclavian or subclavian-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. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 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.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, 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 | 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) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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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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