© Copyright 2025 American Medical Association. All rights reserved.
A bypass graft is a surgical procedure designed to create an alternative pathway for blood flow around a diseased or obstructed segment of the common carotid artery, specifically directing blood to the ipsilateral internal carotid artery. This procedure utilizes a graft that is not derived from the patient's own veins, which may include synthetic materials. The operation is performed through an incision in the neck, allowing the surgeon to access the common carotid artery directly. During the procedure, clamps are applied to the artery to control blood flow and ensure a sterile environment for the grafting process. The surgeon may ligate the artery above the obstruction, securing one end of the graft to the common carotid artery. After the graft is in place, a vessel clamp is used to temporarily occlude the graft while the arterial clamp is released, enabling the surgeon to check for any leaks at the anastomosis site. Subsequently, the internal carotid artery is accessed, and the other end of the graft is sutured into it, ensuring that blood can flow freely through the newly established route. The procedure concludes with a thorough inspection for leaks and patency of the graft before the neck incision is closed, effectively restoring adequate blood flow to the brain and reducing the risk of ischemic events.
© Copyright 2025 Coding Ahead. All rights reserved.
The bypass graft procedure described by CPT® Code 35601 is indicated for patients who present with significant obstruction or disease in the common carotid artery that may compromise blood flow to the brain. The following conditions may warrant this surgical intervention:
The procedure for performing a bypass graft from the common carotid artery to the ipsilateral internal carotid artery involves several critical steps:
After the bypass graft procedure, patients typically require monitoring for any complications, such as bleeding or infection at the incision site. Recovery may involve a hospital stay for observation, and patients are often advised to follow up with their healthcare provider to assess the success of the graft and ensure proper healing. Rehabilitation may include lifestyle modifications and possibly medication to manage risk factors associated with carotid artery disease. Regular imaging studies may be recommended to evaluate the patency of the graft and the condition of the carotid arteries post-surgery.
| Short Descr | ART BYP COMMON IPSI CAROTID | Medium Descr | BYP OTH/THN VEIN COMMON-IPSILATERAL CAROTID | Long Descr | Bypass graft, with other than vein; common carotid-ipsilateral internal carotid | 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 | 56 - Other vascular bypass and shunt, not heart |
| 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). | 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). | 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 | 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 | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 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 |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 2007-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |