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A bypass graft procedure, specifically coded as CPT® 35523, involves the surgical replacement of a stenotic or occluded segment of an artery in the arm, extending from the brachial artery to either the ulnar or radial artery, using a venous graft. This procedure is typically indicated for patients suffering from chronic arterial occlusive disease and ischemia of the upper extremity, conditions that may arise due to factors such as immunosuppression or renal failure. The surgical approach begins with an incision in the upper arm to access the brachial artery, followed by careful dissection of the surrounding soft tissue to expose the artery adequately. Rubber loops are then placed around the artery to isolate it, facilitating the subsequent steps of the procedure. The surgeon then proceeds to the lower arm, making an incision over the ulnar or radial artery, usually at the wrist, to expose the selected artery for grafting. A segment of saphenous vein is harvested from the leg to serve as the bypass graft. The procedure culminates with the suturing of the venous graft to the brachial artery and the selected ulnar or radial artery, ensuring proper blood flow and patency through careful verification techniques such as Doppler ultrasound and palpation of distal pulses.
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The bypass graft procedure coded as CPT® 35523 is indicated for the following conditions:
The procedure for a bypass graft using vein, specifically from the brachial artery to the ulnar or radial artery, involves several critical steps:
Post-procedure care for patients undergoing a bypass graft includes monitoring for any signs of complications such as infection, graft failure, or bleeding. Patients are typically observed for a period to ensure stable vital signs and adequate blood flow to the extremities. Follow-up appointments are essential to assess the graft's patency and the overall recovery process. Rehabilitation may be recommended to improve arm function and circulation, depending on the patient's condition and recovery progress.
| Short Descr | ART BYP GRFT BRCHL-ULNR-RDL | Medium Descr | BYPASS W/VEIN BRACHIAL-ULNAR/-RADIAL | Long Descr | Bypass graft, with vein; brachial-ulnar or -radial | 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) | P2B - Major procedure, cardiovascular-Aneurysm repair | MUE | 1 | CCS Clinical Classification | 55 - Peripheral vascular bypass |
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. | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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). | 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) |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 2008-01-01 | Added | First appearance in code book in 2008. |
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