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The CPT® Code 35633 refers to a surgical procedure known as a bypass graft, specifically an ilio-mesenteric bypass graft using synthetic conduit rather than a vein. This procedure is performed to circumvent a diseased or obstructed segment of the superior mesenteric artery, which is crucial for supplying blood to the intestines and other abdominal organs. The ilio-mesenteric bypass graft aims to restore adequate blood flow to vital structures such as the liver, stomach, esophagus, spleen, and pancreas. During the procedure, the common iliac artery is accessed, and a synthetic graft is meticulously placed to create a new pathway for blood flow, effectively bypassing the affected area. This intervention is essential for patients experiencing significant vascular obstruction that could lead to ischemia or other serious complications. The use of synthetic materials in the graft allows for a durable and effective solution to restore circulation in cases where vein grafts are not feasible.
© Copyright 2025 Coding Ahead. All rights reserved.
The ilio-mesenteric bypass graft procedure (CPT® Code 35633) is indicated for patients who present with significant vascular obstruction or disease affecting the superior mesenteric artery. This condition may lead to inadequate blood supply to the intestines and other abdominal organs, resulting in symptoms such as abdominal pain, weight loss, and malnutrition. The procedure is typically considered when conservative management has failed, and there is a need to restore proper blood flow to prevent ischemic complications.
The ilio-mesenteric bypass graft procedure involves several critical steps to ensure successful graft placement and restoration of blood flow. Initially, the surgeon exposes and isolates the common iliac artery on either the right or left side. Following this, vascular clamps are applied to the iliac artery, and an incision is made to facilitate the attachment of the synthetic bypass graft. The graft is then sutured in an end-to-side configuration to the iliac artery, establishing a new pathway for blood flow. Next, the superior mesenteric artery is clamped and incised, allowing for the anastomosis of the synthetic bypass graft to the mesenteric artery in an end-to-side fashion. This step is crucial as it bypasses the diseased or obstructed portion of the mesenteric artery. Once the graft is securely in place, the clamps are released, and the surgeon checks the blood flow through the graft using Doppler ultrasound to ensure that the procedure has been successful.
After the ilio-mesenteric 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 graft function through follow-up Doppler studies. Patients may also be advised on dietary modifications and gradual resumption of normal activities. The recovery period can vary based on individual health status and the extent of the surgery, but close follow-up with the healthcare team is essential to ensure optimal outcomes and address any potential issues promptly.
| Short Descr | ART BYP ILIO-MESENTERIC | Medium Descr | BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC | Long Descr | Bypass graft, with other than vein; ilio-mesenteric | 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) | P1G - Major procedure - 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. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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). | 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 | GW | Service not related to the hospice patient's terminal condition | 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) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 2009-01-01 | Added | - |