0213098
Bypass Coronary Artery, Four or More Arteries to Internal Mammary, Right with Autologous Venous Tissue, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 2 Heart and Great Vessels |
| Operation | 1 Bypass |
| Body Part | 3 Coronary Artery, Four or More Arteries |
| Approach | 0 Open |
| Device | 9 Autologous Venous Tissue |
| Qualifier | 8 Internal Mammary, Right |
Operation Definition
Altering the route of passage of the contents of a tubular body part
Procedure Overview
Bypass procedures on the heart and great vessels reroute blood around a blocked or narrowed segment of a coronary artery or great vessel, restoring blood flow to tissue that would otherwise be starved of oxygen. Coronary artery bypass grafting is the best-known example, where a segment of the patient's own vein or artery, or a synthetic conduit, is connected from the aorta to a point on a coronary artery past a blockage, giving blood a new path around diseased, narrowed vessel. These procedures are performed for significant coronary artery disease or great vessel obstruction that cannot be adequately managed with medication or a less invasive approach like angioplasty.
Bypass is distinct in ICD-10-PCS because the coded body part is the vessel supplying blood (the origin of the bypass) and the qualifier identifies the vessel or structure the flow is being routed to, rather than the blockage itself being treated. The number of vessels bypassed and the conduit material both matter clinically and for coding, since a triple bypass using a mix of arterial and venous grafts is captured as separate codes for each distinct bypass performed.
Anatomy & Axis Detail
Coronary Artery, Four or More Arteries
A four-or-more-artery bypass addresses diffuse coronary artery disease spanning most of the heart's major supply routes, typically the left anterior descending, diagonal, circumflex or obtuse marginal, and right coronary arteries. This extent of disease usually results from long-standing atherosclerosis and often prompts a heart team decision favoring surgery over percutaneous intervention because stenting cannot durably cover so many separate lesions. The operation extends cardiopulmonary bypass time and typically combines an internal mammary artery graft with multiple saphenous vein or radial artery segments, each routed from an origin such as the aorta to a distinct coronary target past its occlusion. Because coding tracks the number of distinct sites bypassed rather than the number of conduits used, four or more separate coronary destinations must be documented, along with the origin and material for each graft, since mixed autologous and nonautologous conduits are coded as separate procedures.
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: Autologous Venous Tissue
Autologous Venous Tissue describes a vein harvested from the patient's own body, commonly the saphenous vein, and used as a graft or conduit elsewhere in the same patient, as in coronary or peripheral bypass. Being autologous, it avoids rejection risk associated with donor or synthetic material, and it is distinguished from Autologous Arterial Tissue by originating from venous rather than arterial vasculature.
Qualifier: Internal Mammary, Right
This Bypass qualifier specifies that the right internal mammary artery serves as the graft conduit connecting to a coronary artery, a technique used less frequently than the left-sided counterpart in coronary artery bypass grafting. It is distinguished from Internal Mammary, Left by laterality and from Coronary Artery or Aorta qualifiers, which denote different graft sources.
Coding & Documentation
Coders need the operative note to state, for each individual bypass, the proximal origin of the graft, the distal target vessel, and the type of conduit used - internal mammary artery, saphenous vein, radial artery, or synthetic graft - since each of these determines a distinct body part, qualifier, and device value. A common mistake is coding all grafts in a multi-vessel bypass under one code rather than one code per distinct vessel bypassed, since PCS requires each bypass with a different body part or qualifier combination to be reported separately. Documentation should also make clear whether the procedure was done via open sternotomy or a minimally invasive approach, since the approach value changes accordingly, and confirm whether cardiopulmonary bypass (extracorporeal circulation) was used, which is captured with a separate code for the perfusion service itself.