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Official Description

Bypass graft, with vein; iliofemoral

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

An iliofemoral bypass graft using vein is a surgical procedure designed to restore blood flow in the iliac and femoral arteries, which are critical vessels supplying blood to the lower extremities. This procedure is indicated when there is significant obstruction or blockage in these arteries, which can lead to reduced blood flow and potential complications such as claudication or limb ischemia. The surgery involves accessing the abdominal region to expose the iliac arteries, allowing the surgeon to create a bypass route using a vein graft, typically harvested from the patient's leg. The procedure entails careful dissection of the iliac arteries and the creation of a tunnel for the graft, ensuring that blood can flow freely from the iliac artery to the femoral artery. The use of Doppler ultrasound during the procedure helps confirm that the graft is functioning properly and that blood flow is restored effectively. This surgical intervention is crucial for patients experiencing severe vascular issues in the lower body, aiming to improve their overall circulation and quality of life.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The iliofemoral bypass graft procedure is typically indicated for patients experiencing significant vascular obstruction in the iliac and femoral arteries. The following conditions may warrant this surgical intervention:

  • Peripheral Artery Disease (PAD) - A condition characterized by narrowed arteries reducing blood flow to the limbs, often leading to pain and mobility issues.
  • Claudication - Pain or cramping in the legs or buttocks during physical activities due to inadequate blood flow.
  • Critical Limb Ischemia - A severe obstruction of the arteries that significantly reduces blood flow, potentially leading to tissue loss or gangrene.
  • Rest Pain - Pain in the feet or toes while resting, indicating severe arterial insufficiency.

2. Procedure

The iliofemoral bypass graft procedure involves several critical steps to ensure successful graft placement and restoration of blood flow. The following procedural steps are performed:

  • Step 1: Exposure of the Iliac Arteries - The abdomen is opened to access the iliac arteries. Both iliac arteries are carefully dissected free from surrounding tissue to allow for proper visualization and manipulation.
  • Step 2: Creation of the Abdominal Tunnel - A tunnel is created between the iliac arteries to facilitate the placement of a cross-over graft. This step is crucial for connecting the graft from one iliac artery to the other.
  • Step 3: Harvesting the Vein Graft - A vein graft, often the saphenous vein, is harvested from the leg. An incision is made over the section of the saphenous vein, and surrounding soft tissue is dissected away. The vein branches are ligated and divided, and the desired section of the vein is ligated proximally and distally, then removed.
  • Step 4: Clamping and Incising the Iliac Artery - The iliac artery on the unobstructed side is clamped and incised. The proximal end of the vein graft is then sutured to the iliac artery, establishing the first connection.
  • Step 5: Passing the Graft Through the Tunnel - The vein graft is passed through the previously created tunnel to reach the contralateral iliac artery.
  • Step 6: Clamping and Suturing the Contralateral Iliac Artery - The contralateral iliac artery is clamped and incised, and the distal end of the graft is sutured to this artery, completing the bypass connection.
  • Step 7: Hemostasis and Flow Check - Vascular clamps are released, and the suture lines are checked for hemostasis. Blood flow through the graft is assessed using Doppler ultrasound, and distal pulses are evaluated to ensure the patency of the bypass graft.

3. Post-Procedure

After the iliofemoral bypass graft procedure, patients are typically monitored for any signs of complications, such as bleeding or infection at the surgical site. Recovery may involve a hospital stay where vital signs and graft function are closely observed. Patients are often advised on activity restrictions and may require physical therapy to aid in rehabilitation. Follow-up appointments are essential to assess the success of the graft and to monitor for any potential issues with blood flow in the lower extremities.

Short Descr ART BYP GRFT ILIOFEMORAL
Medium Descr BYPASS W/VEIN ILIOFEMORAL
Long Descr Bypass graft, with vein; iliofemoral
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.
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).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
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.
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.
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
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
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)
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
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2013-01-01 Changed Short Descriptor changed.
Pre-1990 Added Code added.
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