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A bypass graft using other than vein is a surgical procedure performed on the arteries of the lower extremity, specifically targeting the popliteal-tibial or peroneal arteries. This procedure is indicated when there is a need to restore blood flow to the lower leg due to blockages or narrowing of the arteries that can lead to ischemia or other complications. The surgery involves creating a new pathway for blood to flow, bypassing the obstructed segment of the artery. In this case, the procedure is performed through an incision made behind the knee, allowing access to the popliteal artery. The distal anastomosis site is also prepared, which may involve the anterior tibial, posterior tibial, or peroneal arteries. A synthetic graft is utilized instead of a vein, which is selected based on the size required for the grafting. The graft is then surgically attached to both the proximal and distal ends of the artery, ensuring that blood can flow freely through the newly created bypass. This procedure is critical for patients suffering from peripheral artery disease or other vascular conditions that compromise blood circulation in the lower extremities.
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The bypass graft procedure using other than vein is indicated for patients experiencing significant arterial blockages or narrowing in the lower extremities, particularly affecting the popliteal, tibial, or peroneal arteries. The following conditions may warrant this surgical intervention:
The procedure for a bypass graft with other than vein involves several critical steps to ensure successful grafting and restoration of blood flow. The following procedural steps are performed:
Post-procedure care involves monitoring the patient for any signs of complications, ensuring that the graft remains patent, and that blood flow is adequate. Patients may require follow-up imaging studies to assess the success of the graft. Pain management and rehabilitation may also be necessary to aid recovery and improve mobility. Regular follow-up appointments are essential to monitor the patient's progress and to address any potential issues that may arise following the surgery.
| Short Descr | ART BYP POP-TIBL-PRL-OTHER | Medium Descr | BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART | Long Descr | Bypass graft, with other than vein; popliteal-tibial or -peroneal artery | 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 | 2 | CCS Clinical Classification | 55 - Peripheral vascular bypass |
This is a primary code that can be used with these additional add-on codes.
| 35685 | Addon Code MPFS Status: Active Code APC N CPT Assistant Article Illustration for Code Placement of vein patch or cuff at distal anastomosis of bypass graft, synthetic conduit (List separately in addition to code for primary procedure) | 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) | 35700 | Addon Code MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Reoperation, femoral-popliteal or femoral (popliteal)-anterior tibial, posterior tibial, peroneal artery, or other distal vessels, more than 1 month after original operation (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. | 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). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 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) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| Pre-1990 | Added | Code added. |