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ICD-10-PCS Code 04104KR

Bypass Abdominal Aorta to Lower Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach
“Bypass Abd Aorta to Low Art w Nonaut Sub, Perc Endo” for short

04104KR is a valid billable ICD-10 procedure code for Bypass Abdominal Aorta to Lower Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach. It is found in the 2024 version of the ICD-10 Procedure Coding System (PCS) and can be used in all HIPAA-covered transactions from Oct 01, 2023 - Sep 30, 2024.

Bypass involves:
Altering the route of passage of the contents of a tubular body part. Rerouting contents of a body part to a downstream area of the normal route, to a similar route and body part, or to an abnormal route and dissimilar body part. Includes one or more anastomoses, with or without the use of a device

Percutaneous Endoscopic approach involves:
Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedure

Bypass includes:

  • Coronary artery bypass, colostomy formation

Abdominal Aorta body part includes:

  • Inferior phrenic artery
  • Lumbar artery
  • Median sacral artery
  • Middle suprarenal artery
  • Ovarian artery
  • Testicular artery

Nonautologous Tissue Substitute device includes:

  • Acellular Hydrated Dermis
  • Bone bank bone graft
  • Cook Biodesign(R) Fistula Plug(s)
  • Cook Biodesign(R) Hernia Graft(s)
  • Cook Biodesign(R) Layered Graft(s)
  • Cook Zenapro(tm) Layered Graft(s)
  • MIRODERM(tm) Biologic Wound Matrix
  • Tissue bank graft
MS-DRG - Medicare Severity-Diagnosis Related Group
  • MDC 05 Diseases & Disorders of the Circulatory System
    Other Major Cardiovascular Procedures
    • DRG 270 - OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC
    • DRG 271 - OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC
    • DRG 272 - OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC
  • MDC 09 Diseases & Disorders of the Skin, Subcutaneous Tissue & Breast
    Other Skin, Subcutaneous Tissue and Breast Procedures
    • DRG 579 - OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC
    • DRG 580 - OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC
    • DRG 581 - OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC
  • MDC 21 Injuries, Poisonings & Toxic Effects of Drugs
    Other O.R. Procedures for Injuries
    • DRG 907 - OTHER O.R. PROCEDURES FOR INJURIES WITH MCC
    • DRG 908 - OTHER O.R. PROCEDURES FOR INJURIES WITH CC
    • DRG 909 - OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC

ICD-10-PCS code structure for 04104KR — See Table View

1: Section 0 Medical and Surgical
2: Body System 4 Lower Arteries
3: Root Operation 1 Bypass
4: Body Part 0 Abdominal Aorta
5: Approach 4 Percutaneous Endoscopic
6: Device K Nonautologous Tissue Substitute
7: Qualifier R Lower Artery

See also

  • The ICD-10-PCS Index of common procedure terms.
  • Medical and Surgical terms in the ICD-10-PCS Definitions table. These definitions may also provide additional explanation and/or examples within this section.
  • The ICD-10-PCS Device Aggregation Table containing entries that correlate a specific ICD-10-PCS device value with a general device value to be used in tables containing only general device values.