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BETA v.3.0

2025 CPT code 35531

Bypass graft, with vein; aortoceliac or aortomesenteric.

Procurement of the saphenous vein graft is included in the bypass procedure. Selective vascular catheterizations should be coded to include all lesser-order catheterizations used in the approach.

Modifiers such as -22 (Increased Procedural Services), -50 (Bilateral Procedure), -59 (Distinct Procedural Service) and others can be used if the circumstances of the procedure require them. Refer to official CPT guidelines for specific scenarios.

Medical necessity must be clearly documented. This includes demonstrating that the patient has significant symptoms or complications due to reduced blood flow in the celiac or mesenteric arteries. The documentation must support that the benefits of surgery outweigh the risks and that less invasive procedures are not suitable options.

The surgeon prepares the patient, makes the necessary incisions to expose the aorta and target artery, harvests the vein graft, attaches the graft to both the aorta and the target artery, ensures proper blood flow, and closes the incisions.

IMPORTANT:For harvesting of an upper extremity vein in addition to bypass, use 35500. For harvesting of a femoropopliteal vein segment in addition to bypass, use 35572. For harvesting and construction of an autogenous composite graft from two distant locations in addition to bypass, use 35682; for three or more segments, use 35683. Procurement of saphenous vein is included in 35501-35587.

In simple words: This procedure reroutes blood flow to the stomach, liver, spleen, and intestines by creating a detour around a blocked artery using a healthy vein from elsewhere in the body. This new pathway allows blood to reach these organs, preventing serious complications.

This code describes a surgical procedure where a blockage in the blood vessels supplying the celiac or mesenteric arteries is bypassed using a vein graft from another part of the patient's body. One end of the graft is attached to the aorta and the other to the celiac or mesenteric artery beyond the blockage, restoring blood flow.

Example 1: A patient with severe stenosis of the celiac artery causing intestinal ischemia undergoes a bypass from the aorta to the celiac artery using a saphenous vein graft., A patient with chronic mesenteric ischemia due to a blockage in the superior mesenteric artery undergoes an aortomesenteric bypass with a great saphenous vein graft., A patient with a significant stenosis of the common hepatic artery, despite attempts at angioplasty, requires a bypass graft from the aorta to the hepatic artery using an autologous vein graft.

Documentation should include details of the blocked artery, the source of the vein graft, intraoperative findings, the type of bypass created, and any complications encountered. Preoperative imaging studies and diagnostic reports confirming the diagnosis and medical necessity should also be included.

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