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The CPT® Code 35632 refers to a surgical procedure known as a bypass graft, specifically designed for the ilio-celiac region using a synthetic conduit rather than a vein. This procedure is performed to create an alternative pathway for blood flow around a diseased or obstructed segment of the celiac axis, which is crucial for supplying blood to vital organs such as the liver, stomach, esophagus, spleen, and pancreas. The process begins with the exposure and isolation of the common iliac artery, which can be accessed from either the right or left side of the body. The surgical approach involves making an incision in the abdomen, separating the omentum from the transverse colon, and carefully exposing the celiac axis. During the procedure, the arteries branching from the celiac axis, including the hepatic, left gastric, and splenic arteries, are thoroughly evaluated to determine the extent of the obstruction. A synthetic bypass graft of appropriate size is then selected to facilitate the bypass. The surgical team applies vascular clamps to the iliac artery to control blood flow, allowing for a precise incision. The synthetic graft is sutured in an end-to-side configuration to the iliac artery, followed by clamping and incising the celiac artery. The graft is then anastomosed to the celiac artery in a similar end-to-side manner, effectively bypassing the obstructed area. After the clamps are released, the blood flow through the graft is assessed using Doppler ultrasound to ensure proper function and restoration of circulation.
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The ilio-celiac bypass graft procedure (CPT® Code 35632) is indicated for patients who present with conditions that result in obstruction or disease of the celiac axis. This may include:
The ilio-celiac bypass graft procedure involves several critical steps to ensure successful grafting and restoration of blood flow. The procedure is initiated with the patient under anesthesia, followed by an abdominal incision to access the common iliac artery.
Following the ilio-celiac bypass graft procedure, patients are typically monitored for any signs of complications, such as bleeding or graft failure. Post-operative care may include pain management, monitoring vital signs, and ensuring proper wound care. Patients may also undergo imaging studies to assess the patency of the graft and confirm that blood flow to the abdominal organs has been successfully restored. Recovery time can vary based on the individual patient's health status and the complexity of the procedure, but follow-up appointments are essential to monitor the long-term success of the graft and overall vascular health.
| Short Descr | ART BYP ILIO-CELIAC | Medium Descr | BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC | Long Descr | Bypass graft, with other than vein; ilio-celiac | 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 |
| 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). | 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.) | 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 | - |