03150JC
Bypass Axillary Artery, Right to Lower Leg Artery, Bilateral with Synthetic Substitute, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 3 Upper Arteries |
| Operation | 1 Bypass |
| Body Part | 5 Axillary Artery, Right |
| Approach | 0 Open |
| Device | J Synthetic Substitute |
| Qualifier | C Lower Leg Artery, Bilateral |
Operation Definition
Altering the route of passage of the contents of a tubular body part
Procedure Overview
Bypass procedures on the upper arteries reroute blood flow around a blocked or narrowed segment of an artery serving the head, neck, or upper extremities, using either a graft vessel or a rerouted native artery to reconnect blood supply beyond the obstruction. Common targets include the carotid, subclavian, axillary, and brachial arteries, where atherosclerotic disease can starve the brain, arm, or hand of adequate blood flow.
Surgeons perform these bypasses when angioplasty and stenting are unlikely to hold, when the blockage is too long or calcified for endovascular repair, or when a prior stent has failed. A graft, taken from the patient's own vein or a synthetic tube, is sewn in above and below the diseased segment so blood detours around it.
The goal is to protect against stroke, arm ischemia, or tissue loss by restoring adequate perfusion, and the operation is typically considered after imaging confirms the location and severity of the narrowing.
Anatomy & Axis Detail
Axillary Artery, Right
The right axillary artery continues from the subclavian artery as it passes through the axilla and supplies the right upper limb, making it a common site for bypass in patients with upper extremity ischemia, trauma, or as an inflow or outflow site for other vascular reconstructions, including some cardiac assist device configurations. Bypass here reroutes blood flow around an occluded or diseased segment using autologous vein or prosthetic graft material, with the axillary location offering relatively accessible surgical exposure compared with more proximal vessels like the subclavian or innominate arteries. Its course near the brachial plexus means dissection and graft placement must account for adjacent neural structures, and documentation should specify the proximal and distal anastomotic sites.
Approach: Open
Open approach means the surgeon cuts through skin, mucous membrane, or other tissue layers to physically expose the target site to view before performing the procedure. It gives direct visualization and hands-on access, distinguishing it from Percutaneous approaches where instruments pass through a small puncture without exposing the site. Open is typical for procedures needing wide access, such as most laparotomies.
Device: Synthetic Substitute
Synthetic Substitute designates a device made from manufactured, non-biologic material, such as mesh or prosthetic components, used to replace or augment a body part. It is distinguished from the two tissue substitute categories by its artificial composition, which carries different considerations for integration and long-term durability than biologic grafts.
Qualifier: Lower Leg Artery, Bilateral
Used when a lower leg artery procedure, such as balloon angioplasty for peripheral arterial disease, is carried out on both legs during the same session. It condenses what would otherwise be two unilateral codes (right and left) into one bilateral qualifier. It should not be applied if only one leg's vessel was accessed or if a more specific named vessel like peroneal is documented for both sides.
Coding & Documentation
Assigning a bypass code from this family requires documentation of both the proximal and distal anatomic sites the graft connects, since ICD-10-PCS bypass coding is built around a 'from-to' body part convention rather than a single location. The operative report must also specify graft material (autologous vein, synthetic, or other) because the device value changes accordingly. A recurring mistake is coding only the diseased artery without capturing the second, distal qualifier that defines where the bypass terminates; another is confusing a bypass with an endarterectomy, which clears the vessel rather than routing around it.