© Copyright 2025 American Medical Association. All rights reserved.
A bypass graft is a surgical procedure designed to create an alternative pathway for blood flow around a diseased or obstructed segment of the lower aorta, specifically to one or both iliac arteries. In this procedure, a graft made from materials other than the patient's own veins is utilized. The choice of synthetic grafts is often preferred due to their ability to accommodate the larger diameters of the aorta and iliac arteries, which can enhance blood flow and reduce the risk of complications associated with using natural vein material. The procedure typically involves making an incision in the lower abdomen to access the aorta. Once the aorta is exposed, clamps are applied above the area of obstruction to control blood flow. The surgeon may tie off the aorta above the diseased section and then attach one end of the graft to the aorta. After securing the graft, the clamp is released to check for any leaks at the connection site, known as the anastomosis. Subsequently, the iliac artery is clamped distal to the graft site, and the other end of the graft is sutured into the iliac artery. The graft site is again assessed for leaks and patency before the abdominal incision is closed. This surgical intervention effectively reroutes blood flow, bypassing the obstructed area of the aorta and restoring adequate circulation to the lower extremities.
© Copyright 2025 Coding Ahead. All rights reserved.
The bypass graft procedure, specifically the aortobi-iliac bypass graft, is indicated for patients experiencing significant vascular obstruction or disease affecting the lower aorta and iliac arteries. This condition may manifest as symptoms such as claudication, which is characterized by pain or cramping in the legs during physical activity due to inadequate blood flow. Other indications may include critical limb ischemia, where there is severe reduction in blood flow that can lead to tissue damage or necrosis, and the presence of aneurysms or other vascular abnormalities that compromise blood circulation. The procedure is performed to restore adequate blood flow to the lower extremities, thereby alleviating symptoms and preventing further complications associated with vascular insufficiency.
The aortobi-iliac bypass graft procedure involves several critical steps to ensure successful rerouting of blood flow. First, the surgeon makes a lower abdominal incision to access the aorta. Once the incision is made, the aorta is carefully exposed, and clamps are applied above the diseased or obstructed segment to control blood flow during the procedure. In some cases, the aorta may be tied off above the obstruction to facilitate the attachment of the graft. The next step involves suturing one end of the synthetic graft to the aorta, ensuring a secure connection. After the graft is in place, the clamp is released to test for any leaks at the anastomosis site, which is the junction where the graft meets the aorta. Following this, the iliac artery is clamped distal to the graft site to prepare for the next connection. The surgeon then makes an incision to access the iliac artery, where the other end of the graft is sutured into place. Once the graft is secured to the iliac artery, the site is checked again for leaks and patency to confirm that blood can flow freely through the new pathway. Finally, the abdominal incision is closed, completing the procedure and establishing a new route for blood to bypass the obstructed portion of the aorta.
After the aortobi-iliac bypass graft procedure, patients typically require monitoring for any complications, such as bleeding or infection at the surgical site. Post-operative care may include pain management, wound care, and monitoring of vital signs to ensure stability. Patients are often advised to engage in gradual physical activity to promote circulation and recovery, while avoiding strenuous activities until cleared by their healthcare provider. Follow-up appointments are essential to assess the success of the graft and to monitor for any potential issues, such as graft occlusion or restenosis. Overall, the post-procedure phase is critical for ensuring optimal recovery and long-term success of the bypass graft.
| Short Descr | ART BYP AORTOBI-ILIAC | Medium Descr | BYP OTH/THN VEIN AORTOBI-ILIAC | Long Descr | Bypass graft, with other than vein; aortobi-iliac | 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) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | 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 |
| 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. | 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). | 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) |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 2007-01-01 | Added | First appearance in code book in 2007. |