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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 that connects the aorta to one or both femoral arteries. The surgery is typically performed through a lower abdominal incision, allowing the surgeon to access the aorta directly. During the procedure, clamps are applied to the aorta above the area of obstruction to control blood flow, and the aorta may be tied off to isolate the diseased section. One end of the harvested vein graft is then sutured to the aorta, and a vessel clamp is placed on the venous graft while the aortic clamp is released to check for any leaks at the anastomosis site, which is the junction where the graft is attached. Following this, the femoral artery is clamped distal to the anastomosis site, and the other end of the venous graft is sutured into the iliac artery. The graft site is again assessed for leaks and patency before the abdominal incision is closed. This surgical intervention effectively restores blood flow to the lower extremities by bypassing the obstructed portion of the aorta, thereby alleviating symptoms associated with reduced blood supply, such as pain or claudication. The CPT® code 35540 is specifically designated for this procedure, which involves bypass grafting from the aorta to both femoral vessels, distinguishing it from similar procedures that may involve only one femoral artery.
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The bypass graft procedure, coded as CPT® 35540, is indicated for patients experiencing significant arterial obstruction or disease affecting the lower aorta, which can lead to inadequate blood flow to the lower extremities. The following conditions may warrant this surgical intervention:
The procedure for aortobifemoral bypass grafting involves several critical steps to ensure successful creation of the graft and restoration of blood flow. The following outlines the procedural steps:
After the aortobifemoral bypass graft procedure, patients typically require close monitoring in a recovery area. Post-operative care includes managing pain, monitoring for any signs of complications such as infection or graft failure, and ensuring proper blood flow to the lower extremities. Patients may be advised to engage in gradual physical activity as tolerated, and follow-up appointments will be necessary to assess the success of the graft and overall recovery. Additionally, lifestyle modifications and medication may be recommended to manage underlying conditions such as diabetes or hypertension, which can impact vascular health.
| Short Descr | ART BYP GRFT AORTBIFEMORAL | Medium Descr | BYPASS W/VEIN AORTOBIFEMORAL | Long Descr | Bypass graft, with vein; aortobifemoral | 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) | 1 - Statutory payment restriction for assistants at surgery applies 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. | 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. | 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 | 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. |
| 2007-01-01 | Added | First appearance in code book in 2007. |
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