CPT 35633 Iliac-to-Mesenteric Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35633: Iliac-to-Mesenteric Artery Bypass with Synthetic Graft

CPT code 35633 denotes an open vascular surgical procedure in which a synthetic graft is used to bypass a blockage in the mesenteric artery by connecting the iliac artery to a segment distal to the occlusion. Nationally, this code represents a high-acuity revascularization procedure for mesenteric ischemia or critical mesenteric arterial occlusion that requires specialized vascular surgical teams and inpatient operative resources. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, payer coverage landscape, common billing modifiers, and the types of benchmarks and policy updates typically relevant to high-cost vascular inpatient procedures. The publication outlines expected sites of service, typical service characteristics, and areas where documentation and coding precision commonly affect reimbursement and utilization monitoring. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes are noted as unavailable in their respective sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35633mesenteric bypassvascular surgerysynthetic graftiliac-to-mesenteric bypassinpatient surgerymesenteric ischemiarevascularization

Billing Code Overview

CPT code 35633 describes a surgical bypass using a synthetic graft to reroute blood flow from the iliac artery around an occluded segment of the mesenteric artery. This procedure is performed to restore mesenteric perfusion when direct repair or endovascular approaches are not suitable.

Service type: Open surgical arterial bypass involving a synthetic graft
Typical site of service: Inpatient operating room or vascular surgery suite in an acute care hospital setting

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with a history of peripheral arterial disease, atherosclerosis, chronic mesenteric ischemia, and marked postprandial abdominal pain and weight loss presents after noninvasive vascular studies and CT angiography demonstrate high-grade stenosis or occlusion of the superior mesenteric artery. Conservative measures and endovascular attempts are unsuccessful or anatomically unsuitable. The vascular surgeon schedules an open mesenteric bypass using a synthetic graft from the common or external iliac artery to bypass the diseased segment of the mesenteric artery.

Preoperative workflow includes vascular lab duplex, CTA or MRA for operative planning, cardiopulmonary risk assessment, informed consent, and perioperative anticoagulation/antiplatelet management. Intraoperative workflow involves general anesthesia, laparotomy or retroperitoneal exposure, proximal control at the iliac artery, distal anastomosis to the mesenteric artery beyond the obstruction, graft routing and tunneling, confirmation of graft flow (doppler/flow probe), and hemostasis. Postoperative care includes ICU or step-down monitoring for perfusion, graft patency surveillance with duplex, wound care, and adjustment of antiplatelet therapy.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard reporting	Use when no specific modifier applies and the procedure is billed normally.

CPT 35666: Femoral-to-Tibial/Peroneal Bypass with Synthetic Graft

CPT-35616-SUBCLAVIAN-TO-AXILLARY-BYPASS-SYNTHETIC-GRAFT

CPT 35616: Subclavian-to-Axillary Bypass with Synthetic Graft

CPT-35636-SPLENIC-TO-RENAL-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35636: Splenic-to-Renal Artery Bypass with Synthetic Graft

CPT-35600-ARTERIAL-GRAFT-HARVEST-ARM-FOR-CORONARY-BYPASS

CPT 35600: Arterial Graft Harvest from Arm for Coronary Bypass

CPT-35645-SUBCLAVIAN-TO-VERTEBRAL-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35645: Subclavian-to-Vertebral Artery Bypass with Synthetic Graft

CPT-35642-CAROTID-TO-VERTEBRAL-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35642: Carotid-to-Vertebral Artery Bypass with Synthetic Graft

CPT-35638-AORTO-BILATERAL-ILIAC-BYPASS-SYNTHETIC-GRAFT

CPT 35638: Aorto to Bilateral Iliac Bypass with Synthetic Graft

CPT-35623-AXILLARY-TO-POPLITEAL-OR-TIBIAL-BYPASS-SYNTHETIC-GRAFT

CPT 35623: Axillary-to-Popliteal/Tibial Bypass with Synthetic Graft

CPT-35647-AORTO-FEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35647: Aorto-Femoral Bypass with Synthetic Graft

CPT-35601-CAROTID-COMMON-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35601: Common Carotid Artery Bypass with Synthetic Graft

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Taxonomy Code	Specialty	Notes
`208000000X`	Vascular Surgery	Primary specialty performing open mesenteric bypass procedures.
`207L00000X`	Surgery — Cardiovascular	Cardiovascular surgeons with vascular expertise may perform complex mesenteric reconstructions.
`207R00000X`	General Surgery	General surgeons with vascular training perform mesenteric bypass in some centers.
`363L00000X`	Interventional Radiology	Provides diagnostic angiography and endovascular alternatives; may assist in hybrid procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K55.1`	Chronic vascular disorders of intestine	Primary indication for mesenteric bypass when chronic ischemia causes symptoms and ischemic lesions.
`K55.0`	Acute vascular disorders of intestine	May prompt urgent revascularization when acute-on-chronic mesenteric ischemia is present.
`I70.2`	Atherosclerosis of native arteries of the extremities (includes mesenteric atherosclerosis)	Underlying atherosclerotic disease causing mesenteric arterial occlusion or stenosis.
`I82.3`	Embolism and thrombosis of arteries of abdomen	Embolic occlusion of mesenteric vessels sometimes requiring bypass if thrombectomy/endovascular therapy insufficient.
`K55.9`	Vascular disorder of intestine, unspecified	Used when mesenteric ischemia is documented but specific subtype is not yet assigned.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36147`	Selective catheter placement, visceral branch, with angiography, radiological supervision and interpretation	Diagnostic mesenteric angiography used preoperatively or intraoperatively to define lesion and confirm flow.
`35634`	Extra-anatomic bypass, with graft, for mesenteric revascularization; using vein graft	Alternative graft type — a vein graft procedure that may be chosen instead of a synthetic graft.
`37618`	Lower extremity arterial bypass, other than fem-pop, with prosthetic graft	Related bypass techniques and graft handling codes; shares surgical principles, used in billing bundles or comparative coding.
`93971`	Duplex scan of arterial inflow and runoff, complete bilateral study	Noninvasive postoperative surveillance for graft patency and limb/mesenteric perfusion.
`76937`	Ultrasound guidance for vascular access (e.g., graft assessment, doppler confirmation)	Intraoperative or perioperative ultrasound guidance to assess graft flow or vascular access.

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