© Copyright 2025 American Medical Association. All rights reserved.
A bypass graft, specifically a subclavian-axillary bypass graft, is a surgical procedure designed to create an alternative pathway for blood flow around a diseased or obstructed segment of the artery. This procedure utilizes a synthetic graft rather than a vein, which is significant in cases where the patient's veins may not be suitable for grafting. The subclavian artery, located beneath the collarbone, is often involved in this type of surgery, particularly when there is an obstruction in the axillary artery, which is located in the upper arm. The procedure begins with an incision made at the base of the neck, allowing access to the subclavian artery. A second incision is made in the arm to access the axillary artery. A tunnel is then created to connect these two sites, facilitating the placement of the synthetic graft. This graft is carefully sutured to both the subclavian and axillary arteries, ensuring that blood can flow freely around the obstruction. The use of Doppler ultrasound during the procedure allows the surgeon to confirm that blood flow through the graft is adequate, and the evaluation of distal pulses ensures that the bypass is functioning properly. This procedure is critical for restoring adequate blood circulation to the arm and preventing complications associated with arterial obstruction.
© Copyright 2025 Coding Ahead. All rights reserved.
The subclavian-axillary bypass graft procedure is indicated for patients experiencing significant arterial obstruction or disease affecting the axillary artery on the ipsilateral side of the body. This condition may manifest as symptoms such as claudication, ischemic pain, or other signs of reduced blood flow to the arm. The procedure aims to restore adequate blood circulation by rerouting blood flow around the obstructed area, thereby alleviating symptoms and preventing further complications.
The subclavian-axillary bypass graft procedure involves several critical steps to ensure successful graft placement and restoration of blood flow. Initially, an incision is made at the base of the neck, just above the clavicle, to expose the subclavian artery. This access point is crucial for the subsequent steps of the procedure. Following this, a second incision is made in the arm over the axillary artery, which is the target site for the graft's anastomosis. Once both arteries are accessible, a tunnel is created that begins at the exposed section of the subclavian artery and passes under the clavicle, extending to the planned anastomosis site in the axillary artery. This tunnel allows for the smooth passage of the synthetic graft. After preparing the graft, it is sutured to the axillary artery, ensuring a secure connection. Once the graft is in place, vascular clamps are removed to restore blood flow. Throughout the procedure, the surgeon checks blood flow through the graft using Doppler ultrasound and evaluates distal pulses to confirm the patency of the bypass graft.
After the subclavian-axillary bypass graft procedure, patients are typically monitored for any signs of complications, such as bleeding or infection at the incision sites. It is essential to assess the patency of the graft and ensure that blood flow to the arm is adequate. Patients may be advised to follow specific post-operative care instructions, including activity restrictions and wound care. Follow-up appointments are crucial for evaluating the success of the graft and monitoring the patient's recovery. The expected recovery period may vary depending on individual health factors, but patients are generally encouraged to gradually resume normal activities as tolerated, under the guidance of their healthcare provider.
| Short Descr | ART BYP SUBCLAV-AXILLARY | Medium Descr | BYP OTH/THN VEIN SUBCLAVIAN-AXILLARY | Long Descr | Bypass graft, with other than vein; subclavian-axillary | 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 |
| 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. | 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.) | 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. |
| Pre-1990 | Added | Code added. |