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A bypass graft involving the tibial-tibial, peroneal-tibial, or tibial/peroneal trunk-tibial veins is a surgical procedure designed to reroute blood flow around a diseased or obstructed artery in the lower leg. This procedure is essential for restoring adequate blood circulation to the affected area, which is crucial for maintaining tissue viability and preventing complications such as limb ischemia. The surgery begins with an incision over the planned site of the proximal anastomosis, allowing the surgeon to access the underlying soft tissue and muscle fascia. Through careful dissection, the surgeon exposes the affected artery, which may be one of the tibial or peroneal arteries. Control of the artery is achieved by placing a rubber loop around it, ensuring that blood flow can be managed during the procedure. The next step involves creating a tunnel for the bypass graft, which is typically harvested from a vein, often the saphenous vein. The harvested vein is then meticulously prepared and anastomosed to both the proximal and distal ends of the obstructed artery, effectively bypassing the diseased segment. Throughout the procedure, the surgeon monitors blood flow to ensure the graft is functioning properly, utilizing Doppler ultrasound to assess patency and evaluate distal pulses. This comprehensive approach is critical for the successful restoration of blood flow and the overall health of the lower limb.
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The tibial-tibial, peroneal-tibial, or tibial/peroneal trunk-tibial bypass graft procedure is indicated for patients experiencing significant arterial obstruction or disease in the lower leg. The following conditions may warrant this surgical intervention:
The procedure for performing a tibial-tibial, peroneal-tibial, or tibial/peroneal trunk-tibial bypass graft involves several critical steps to ensure successful graft placement and restoration of blood flow.
After the completion of the bypass graft procedure, patients are typically monitored for any signs of complications, such as bleeding or infection. Post-operative care may include pain management, monitoring of vital signs, and assessment of the graft's function. Patients are often advised on mobility restrictions and may require physical therapy to aid in recovery. Follow-up appointments are essential to evaluate the success of the graft and ensure proper healing of the surgical site. Additionally, patients may need to adhere to lifestyle modifications and medication regimens to manage underlying conditions such as peripheral artery disease.
| Short Descr | ART BYP TIBIAL-TIB/PERONEAL | Medium Descr | BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL | Long Descr | Bypass graft, with vein; tibial-tibial, peroneal-tibial, or tibial/peroneal trunk-tibial | 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.
| 35500 | Addon Code MPFS Status: Active Code APC N CPT Assistant Article Harvest of upper extremity vein, 1 segment, for lower extremity or coronary artery bypass procedure (List separately in addition to code for primary procedure) | 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) | 35682 | Addon Code MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Bypass graft; autogenous composite, 2 segments of veins from 2 locations (List separately in addition to code for primary procedure) | 35683 | Addon Code MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Bypass graft; autogenous composite, 3 or more segments of vein from 2 or more locations (List separately in addition to code for primary procedure) | 35686 | Add-on Code MPFS Status: Active Code APC N CPT Assistant Article Illustration for Code Creation of distal arteriovenous fistula during lower extremity bypass surgery (non-hemodialysis) (List separately in addition to code for primary procedure) | 35700 | Addon Code MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Reoperation, femoral-popliteal or femoral (popliteal)-anterior tibial, posterior tibial, peroneal artery, or other distal vessels, more than 1 month after original operation (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). | 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). | 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). | 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. |
| 2009-01-01 | Added | - |
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