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A splenorenal bypass graft using other than vein is a surgical procedure designed to create a new pathway for blood flow around a diseased or obstructed segment of the renal artery, which supplies blood to the kidney. This procedure is particularly important when the renal artery is compromised, as it can lead to reduced blood flow and potential kidney damage. The surgery involves making an incision in the abdomen to access the necessary vascular structures. During the operation, the surgeon evaluates the celiac axis, which includes the hepatic, left gastric, and splenic arteries, to ensure proper identification and isolation of the splenic artery. The descending duodenum is mobilized to provide better access to the inferior vena cava and renal vein, which are critical landmarks in this procedure. A synthetic graft, rather than a vein, is used to create the bypass, which is essential for restoring adequate blood flow to the kidney. The graft is meticulously sutured in an end-to-side configuration to both the splenic artery and the renal artery, allowing blood to bypass the obstructed area. After the graft is in place, vascular clamps are released, and the blood flow through the graft is assessed using Doppler ultrasound to confirm the success of the procedure.
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The splenorenal bypass graft procedure is indicated for patients who present with specific vascular conditions affecting the renal artery. These indications include:
The procedure for a splenorenal bypass graft involves several critical steps to ensure successful grafting and restoration of blood flow. The steps are as follows:
Post-procedure care for patients undergoing a splenorenal bypass graft includes monitoring for any complications such as bleeding, infection, or graft failure. Patients are typically observed in a recovery area before being transferred to a hospital room for further monitoring. Pain management is provided as needed, and the surgical site is assessed for signs of healing. Follow-up appointments are essential to evaluate the success of the graft and to monitor kidney function. Patients may also require imaging studies to ensure that the graft remains patent and that blood flow to the kidney is adequate.
| Short Descr | ART BYP SPENORENAL | Medium Descr | BYP OTH/THN VEIN SPLENORENAL | Long Descr | Bypass graft, with other than vein; splenorenal (splenic to renal arterial anastomosis) | 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). | 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). | 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) |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| Pre-1990 | Added | Code added. |