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A carotid-vertebral bypass graft using vein is a surgical procedure designed to create a new pathway for blood flow around a diseased or obstructed segment of the vertebral artery. The vertebral arteries, which are critical for supplying blood to the brain, originate from the brachiocephalic artery on the right side and the subclavian artery on the left side. These arteries travel through the cervical spine, specifically passing through the transverse processes of the C6 to C2 vertebrae, and exit at the base of the skull. The procedure involves both an extracranial segment, which is located between the C2 vertebra and the base of the skull, and an intracranial segment that begins at the atlanto-occipital membrane and continues until the two vertebral arteries converge to form the basilar artery. This vascular structure is essential for supplying blood to the brainstem, cerebellum, and occipital lobes. During the procedure, an incision is made over the obstructed segment of the vertebral artery, allowing for dissection and exposure of the artery. A vein graft, often harvested from the saphenous vein in the leg, is then used to bypass the obstruction. The surgical steps include clamping and incising the vertebral artery, suturing the vein graft to both the vertebral and common carotid arteries, and ensuring proper blood flow through the graft by checking with Doppler ultrasound and evaluating distal pulses. This procedure is critical for restoring adequate blood supply to the brain in cases where the vertebral artery is compromised.
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The carotid-vertebral bypass graft procedure is indicated for patients who present with specific conditions affecting the vertebral artery. These indications include:
The carotid-vertebral bypass graft procedure involves several critical steps to ensure successful grafting and restoration of blood flow. The steps are as follows:
Post-procedure care for patients undergoing a carotid-vertebral bypass graft includes monitoring for any complications, such as bleeding or infection at the incision sites. Patients are typically observed for signs of neurological deficits, which may indicate issues with blood flow. Follow-up imaging studies may be required to assess the patency of the graft and ensure that blood flow to the brain is adequate. Patients may also need to adhere to a rehabilitation program to support recovery and improve overall vascular health.
| Short Descr | ART BYP GRFT CAROTID-VERTBRL | Medium Descr | BYPASS W/VEIN CAROTID-VERTEBRAL | Long Descr | Bypass graft, with vein; carotid-vertebral | 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) |
| 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). | 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. | 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) |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| Pre-1990 | Added | Code added. |
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