ICD 10 Code `04104A4`

Bypass Abdominal Aorta to Left Renal Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
“Bypass Abd Aorta to L Renal A w Autol Art, Perc Endo” for short

2025 Billable Code

04104A4 is a valid billable ICD-10 procedure code for Bypass Abdominal Aorta to Left Renal Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach. It is found in the 2025 version of the ICD-10 Procedure Coding System (PCS) and can be used in all HIPAA-covered transactions from Oct 01, 2024 - Sep 30, 2025.

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

MS-DRG - Medicare Severity-Diagnosis Related Group

MDC 05 Diseases & Disorders of the Circulatory System
Aortic and Heart Assist Procedures
- DRG 268 - AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC
- DRG 269 - AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC
MDC 11 Diseases & Disorders of the Kidney & Urinary Tract
Kidney and Ureter Procedures
- DRG 656 - KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC
- DRG 657 - KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC
- DRG 658 - KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC
- DRG 659 - KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC
- DRG 660 - KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC
- DRG 661 - KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM 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
MDC 24 Multiple Significant Trauma
Other Procedures for Multiple Significant Trauma
- DRG 957 - OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC
- DRG 958 - OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC
- DRG 959 - OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

ICD-10-PCS code structure for 04104A4 — 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	`A`	Autologous Arterial Tissue
7: Qualifier	`4`	Renal Artery, Left

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.

See similar ICD-10-PCS procedure code(s) with an alternate qualifier:

Autologous Arterial Tissue

04104A0 - Bypass Abdominal Aorta to Abdominal Aorta with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104A1 - Bypass Abdominal Aorta to Celiac Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104A2 - Bypass Abdominal Aorta to Mesenteric Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104A3 - Bypass Abdominal Aorta to Right Renal Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104A4 - Bypass Abdominal Aorta to Left Renal Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach (current)
04104A5 - Bypass Abdominal Aorta to Bilateral Renal Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104A6 - Bypass Abdominal Aorta to Right Common Iliac Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104A7 - Bypass Abdominal Aorta to Left Common Iliac Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104A8 - Bypass Abdominal Aorta to Bilateral Common Iliac Arteries with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104A9 - Bypass Abdominal Aorta to Right Internal Iliac Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104AB - Bypass Abdominal Aorta to Left Internal Iliac Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104AC - Bypass Abdominal Aorta to Bilateral Internal Iliac Arteries with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104AD - Bypass Abdominal Aorta to Right External Iliac Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104AF - Bypass Abdominal Aorta to Left External Iliac Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104AG - Bypass Abdominal Aorta to Bilateral External Iliac Arteries with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104AH - Bypass Abdominal Aorta to Right Femoral Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104AJ - Bypass Abdominal Aorta to Left Femoral Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104AK - Bypass Abdominal Aorta to Bilateral Femoral Arteries with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104AQ - Bypass Abdominal Aorta to Lower Extremity Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04104AR - Bypass Abdominal Aorta to Lower Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach

ICD 10 Code 04104A4

ICD 10 Code `04104A4`