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A bypass graft, specifically coded as CPT® 35538, involves the surgical creation of a new pathway for blood flow around a diseased or obstructed segment of the lower aorta, extending to one or both iliac arteries. This procedure utilizes a vein that is harvested either from the patient’s own body or from a donor. The surgical approach typically begins with a lower abdominal incision, which allows the surgeon to access and expose the aorta. Once the aorta is visible, clamps are applied above the area of obstruction to control blood flow during the procedure. In some cases, the aorta may be tied off above the obstructed section to facilitate the attachment of the vein graft. The harvested vein graft is then sutured to the aorta, creating an anastomosis, which is a surgical connection between two structures. To ensure the integrity of this connection, a vessel clamp is placed on the venous graft while the aortic clamp is released, allowing the surgeon to check for any leaks at the anastomosis site. Following this, the iliac artery is clamped distal to the anastomosis site, and through a separate incision, the other end of the vein graft is sutured into the iliac artery. This step is crucial as it completes the bypass route, allowing blood to flow past the obstructed area of the aorta. The surgeon will again check for leaks and ensure the patency of the graft before closing the abdominal incision. This procedure is essential for restoring adequate blood flow to the lower extremities when the aorta is compromised.
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The bypass graft procedure coded as CPT® 35538 is indicated for patients who present with significant vascular obstruction or disease affecting the lower aorta and extending to the iliac arteries. This condition may manifest as symptoms such as claudication, which is characterized by pain or cramping in the legs during physical activity due to inadequate blood flow. Other indications may include critical limb ischemia, where there is severe obstruction of blood flow, leading to potential tissue loss or gangrene. The procedure is performed to restore adequate blood circulation to the lower extremities, thereby alleviating symptoms and preventing further complications associated with vascular insufficiency.
The procedure begins with the patient positioned appropriately for access to the lower abdomen. A lower abdominal incision is made to expose the aorta. Once the aorta is accessed, clamps are applied above the diseased or obstructed segment to control blood flow. In some cases, the aorta may be tied off above the obstruction to facilitate the attachment of the vein graft. The vein, which is harvested from the patient or a donor, is then prepared for anastomosis. One end of the harvested vein graft is sutured to the aorta, creating a new pathway for blood flow. After the initial anastomosis, a vessel clamp is placed on the venous graft while the aortic clamp is released. This step is critical as it allows the surgeon to test for any leaks at the anastomosis site. Following this, the iliac artery is clamped distal to the anastomosis site to prepare for the second connection. Through a separate incision, the other end of the vein graft is sutured into the iliac artery, completing the bypass. The surgeon will check the grafted site again for leaks and ensure that blood is flowing properly through the new pathway before closing the abdominal wound. This meticulous process ensures that blood can bypass the obstructed portion of the aorta effectively.
After the completion of the bypass graft procedure, patients are typically monitored in a recovery area for any immediate complications. Post-operative care may include pain management, monitoring vital signs, and assessing the surgical site for any signs of infection or complications. Patients may be advised to engage in gradual mobilization to promote circulation and recovery. Follow-up appointments are essential to evaluate the success of the graft and ensure that blood flow is adequate. Additionally, patients may receive instructions regarding lifestyle modifications and medications to support vascular health and prevent future complications.
| Short Descr | ART BYP GRFT AORTOBI-ILIAC | Medium Descr | BYPASS W/VEIN AORTOBI-ILIAC | Long Descr | Bypass graft, with vein; aortobi-iliac | 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) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | 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 | 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) |
| 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 2007-01-01 | Added | First appearance in code book in 2007. |
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