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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 lower aorta, which is the main artery supplying blood to the lower body. This procedure specifically involves the use of a vein, which can be harvested from the patient or obtained from a donor, to form a graft. The surgery typically begins with a lower abdominal incision to access the aorta. Once the aorta is exposed, clamps are applied above the area of obstruction to control blood flow. In some cases, the aorta may be tied off above the obstructed section. The harvested vein graft is then sutured to the aorta, establishing a new route for blood flow. A vessel clamp is placed on the venous graft while the aortic clamp is released to check for any leaks at the site where the graft is attached, known as the anastomosis site. Following this, the femoral artery is clamped distal to the graft site, and the other end of the vein graft is sutured into the iliac artery. The surgical team will again check for leaks and ensure that the graft is patent, meaning it is open and allowing blood to flow properly, before closing the abdominal incision. This procedure is coded as CPT® Code 35539 when the bypass graft is performed from the aorta to one femoral artery, while CPT® Code 35540 is used when the graft extends to both femoral arteries.
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The bypass graft procedure is indicated for patients who have significant obstruction or disease in the lower aorta that impairs blood flow to the lower extremities. This condition may manifest as symptoms such as claudication, which is pain or cramping in the legs during physical activity due to inadequate blood supply. Other indications may include critical limb ischemia, where there is severe obstruction of blood flow, leading to pain at rest, non-healing wounds, or gangrene. The procedure aims to restore adequate blood flow to the femoral arteries, thereby alleviating symptoms and preventing further complications associated with poor circulation.
The procedure begins with the patient being placed under general anesthesia. A lower abdominal incision is made to access the aorta. Once the incision is made, the surgeon carefully exposes the aorta and applies clamps above the diseased segment to control blood flow. In some cases, the aorta may be tied off above the obstruction. The next step involves harvesting a vein from the patient or using a donor vein, which will serve as the graft. One end of the harvested vein graft is then sutured to the aorta, creating an anastomosis. A vessel clamp is placed on the venous graft while the aortic clamp is released to check for any leaks at the anastomosis site. After confirming that there are no leaks, the femoral artery is clamped distal to the graft site. The other end of the vein graft is then sutured into the iliac artery through a separate incision. The surgical team will again check for leaks and ensure that the graft is patent before closing the abdominal incision. This meticulous process ensures that a new route for blood flow is established, effectively bypassing the obstructed portion of the aorta.
After the bypass graft procedure, patients are typically monitored in a recovery area for any immediate complications. Post-operative care includes managing pain, monitoring vital signs, and ensuring proper blood flow through the graft. Patients may be advised to engage in gradual physical activity as tolerated to promote circulation and recovery. Follow-up appointments are essential to assess the patency of the graft and to monitor for any potential complications, such as infection or thrombosis. The healthcare team will provide specific instructions regarding wound care, activity restrictions, and any prescribed medications, including anticoagulants to prevent blood clots. Overall, the recovery process may vary depending on the individual patient's health status and the complexity of the procedure.
| Short Descr | ART BYP GRFT AORTOFEMORAL | Medium Descr | BYPASS W/VEIN AORTOFEMORAL | Long Descr | Bypass graft, with vein; aortofemoral | 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 | 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. | 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.) | 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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