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An axillary-popliteal or axillary-tibial bypass graft, coded as CPT® 35623, is a surgical procedure designed to reroute blood flow around a diseased or obstructed segment of the vascular system, specifically targeting the aorta, iliac, and/or femoral arteries. This procedure is performed using a synthetic graft rather than a vein, which is significant in cases where the patient's veins may not be suitable for grafting due to disease or other factors. The surgery begins with a skin incision made in the chest area, just below the clavicle, allowing access to the proximal axillary artery. A second incision is then made in the groin region over the common femoral artery or in the leg over the popliteal or tibial artery, facilitating exposure of the necessary arteries for the bypass. The surgical team creates a tunnel that connects the axillary artery to the common femoral artery, or extends further down to the popliteal or tibial artery, depending on the specific bypass being performed. This tunnel is crucial for the placement of the synthetic graft, which is selected based on the size required for optimal blood flow. Once the graft is in place, it is sutured to both the axillary artery and the distal artery, ensuring a secure connection. The procedure concludes with the removal of vascular clamps and verification of blood flow through the graft, typically assessed using Doppler ultrasound, along with an evaluation of distal pulses to confirm the patency of the bypass graft. This detailed approach ensures that blood can flow effectively around the obstructed area, restoring circulation to the lower extremities.
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The axillary-popliteal or axillary-tibial bypass graft procedure is indicated for patients experiencing significant vascular obstruction or disease that impairs blood flow in the aorta, iliac, or femoral arteries. The following conditions may warrant this surgical intervention:
The procedure for an axillary-popliteal or axillary-tibial bypass graft involves several critical steps to ensure successful rerouting of blood flow. The following outlines the procedural steps:
Post-procedure care for patients undergoing an axillary-popliteal or axillary-tibial bypass graft includes monitoring for any signs of complications, such as infection or graft failure. Patients are typically observed for adequate blood flow to the lower extremities, and pain management is provided as needed. Follow-up appointments are essential to assess the graft's patency and overall vascular health. Patients may also be advised on lifestyle modifications and rehabilitation exercises to promote recovery and improve circulation.
| Short Descr | ART BYP AXILLARY-POP-TIBIAL | Medium Descr | BYP OTH/THN VEIN AXILLARY-POPLITEAL/-TIBIAL | Long Descr | Bypass graft, with other than vein; axillary-popliteal or -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.
| 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) |
| 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. | 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.) | 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 | 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. |
| 2011-01-01 | Changed | Short description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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