Coding Ahead
CasePilot
Medical Coding Assistant
Case2Code
Search and Code Lookup Tool
CareerCenter
Medical Coding Job Board
Log in Register free account

Need help choosing the right code?

Ask CasePilot about procedures, modifiers, bundling, and coding guidance.

Try CasePilot
CPT®
35549

CPT® Code 35549
Deleted

Code deleted, see 35537, 35538, 35539, 35540, 35565

Official Description

Bypass graft, with vein; aortoiliofemoral, bilateral

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

A bypass graft, specifically a bilateral aortoiliofemoral vein bypass graft, is a surgical procedure designed to restore blood flow in patients with significant arterial blockages in the aorta and iliac arteries. This procedure involves the use of a vein, typically harvested from the patient's leg, to create a new pathway for blood to bypass the obstructed areas. The term "aortoiliofemoral" refers to the anatomical regions involved: the aorta, which is the main artery supplying blood to the body, the iliac arteries that branch off from the aorta to supply blood to the pelvis and legs, and the femoral arteries that further distribute blood to the lower extremities. The surgery is performed through an incision in the abdomen and groin, allowing the surgeon to access the aorta and iliac arteries directly. The procedure is indicated for patients experiencing symptoms related to peripheral artery disease, such as claudication, ischemic rest pain, or critical limb ischemia, where blood flow is severely compromised. The goal of the bypass graft is to alleviate these symptoms and improve overall blood circulation to the lower limbs, thereby enhancing the patient's quality of life and reducing the risk of complications associated with poor blood flow.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The bilateral aortoiliofemoral bypass graft procedure is indicated for patients with significant arterial occlusions or stenosis affecting the aorta and iliac arteries, which can lead to reduced blood flow to the lower extremities. The following conditions may warrant this surgical intervention:

  • Peripheral Artery Disease (PAD) - A condition characterized by narrowed arteries reducing blood flow to the limbs, often leading to symptoms such as leg pain during physical activity (claudication).
  • Ischemic Rest Pain - Severe pain in the legs or feet that occurs at rest due to inadequate blood supply, indicating critical limb ischemia.
  • Critical Limb Ischemia - A severe obstruction of the arteries that significantly reduces blood flow to the extremities, potentially leading to tissue loss or gangrene.

2. Procedure

The bilateral aortoiliofemoral bypass graft procedure involves several detailed steps to ensure successful graft placement and restoration of blood flow. The following outlines the procedural steps:

  • Step 1: Abdominal Access - The procedure begins with an incision in the abdomen, allowing the surgeon to mobilize the small intestine and access the retroperitoneal space. This space is opened to expose the aorta, which is critical for the bypass graft.
  • Step 2: Dissection of the Aorta and Iliac Arteries - The proximal aorta above the obstructed region is carefully dissected free from surrounding tissues to facilitate the placement of a vascular clamp. Similarly, the iliac artery is also dissected to ensure proper access for the graft.
  • Step 3: Creation of a Tunnel - The retroperitoneum is elevated, and a tunnel is created over the iliac artery to prepare for the placement of the vein bypass graft.
  • Step 4: Groin Incision and Vein Harvesting - An incision is made over the groin to expose the femoral artery. A vein graft, typically the saphenous vein, is harvested from the leg. This involves making an incision over the section of the saphenous vein, dissecting the soft tissue, and ligating and dividing branches before removing the vein.
  • Step 5: Aortic Incision and Graft Placement - A side-biting clamp is placed on the aorta above the obstructed segment. The aorta is then incised, and the first venous graft is sutured to the aorta. The vein graft is passed through the previously created tunnel to the iliac artery.
  • Step 6: Anastomosis to the Iliac Artery - The iliac artery is incised, and the vein graft is anastomosed to the iliac artery, ensuring a secure connection for blood flow.
  • Step 7: Second Graft Placement - Vascular clamps are applied above and below the planned incision sites in the iliac and femoral arteries. A second vein graft is then anastomosed to the iliac vein above the diseased portion, passed through the tunnel to the femoral artery, and anastomosed to the femoral artery.
  • Step 8: Hemostasis and Closure - After verifying hemostasis at the suture sites and checking blood flow to the extremity, the retroperitoneum is closed, followed by the closure of the abdomen and groin incisions.

3. Post-Procedure

Post-procedure care for patients undergoing a bilateral aortoiliofemoral bypass graft includes monitoring for complications such as bleeding, infection, or graft failure. Patients are typically observed in a recovery area before being transferred to a hospital room. Pain management is provided, and patients are encouraged to gradually increase mobility as tolerated. Follow-up appointments are essential to assess the patency of the grafts and monitor the patient's recovery progress. Additionally, lifestyle modifications and adherence to prescribed medications are crucial for optimizing vascular health and preventing future complications.
Short Descr ARTERY BYPASS GRAFT
Medium Descr BYP W/VEIN AORTOILIOFEM BI
Long Descr Bypass graft, with vein; aortoiliofemoral, bilateral
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) 2 - 150% payment adjustment 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 Discontinued Code
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) none
MUE Not applicable/unspecified.
CCS Clinical Classification 55 - Peripheral vascular bypass
Date
Action
Notes
2012-01-01 Deleted Code deleted, see 35537, 35538, 35539, 35540, 35565
Pre-1990 Added Code added.
Code
Description
Code
Description
Code
Description
CasePilot

Get instant expert-level medical coding assistance.

Ask about:
CPT Codes Guidelines Modifiers Crosswalks NCCI Edits Compliance Medicare Coverage
Example: "What is CPT code 99213?" or "Guidelines for E/M services"