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ICD 10 Code 04104J4

Bypass Abdominal Aorta to Left Renal Artery with Synthetic Substitute, Percutaneous Endoscopic Approach
“Bypass Abd Aorta to L Renal A w Synth Sub, Perc Endo” for short

04104J4 is a valid billable ICD-10 procedure code for Bypass Abdominal Aorta to Left Renal Artery with Synthetic Substitute, 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

Synthetic Substitute device includes:

  • AbioCor(R) Total Replacement Heart
  • AMPLATZER(R) Muscular VSD Occluder
  • Annuloplasty ring
  • Bard(R) Composix(R) (E/X)(LP) mesh
  • Bard(R) Composix(R) Kugel(R) patch
  • Bard(R) Dulex(tm) mesh
  • Bard(R) Ventralex(tm) hernia patch
  • Barricaid(R) Annular Closure Device (ACD)
  • BRYAN(R) Cervical Disc System
  • Corvia IASD(R)
  • Ex-PRESS(tm) mini glaucoma shunt
  • Flexible Composite Mesh
  • GORE(R) DUALMESH(R)
  • Holter valve ventricular shunt
  • IASD(R) (InterAtrial Shunt Device), Corvia
  • InterAtrial Shunt Device IASD(R), Corvia
  • LimFlow(tm) Transcatheter Arterialization of the Deep Veins (TADV) System
  • MitraClip valve repair system
  • Nitinol framed polymer mesh
  • Open Pivot (mechanical) valve
  • Open Pivot Aortic Valve Graft (AVG)
  • Partially absorbable mesh
  • PHYSIOMESH(tm) Flexible Composite Mesh
  • Polymethylmethacrylate (PMMA)
  • Polypropylene mesh
  • PRESTIGE(R) Cervical Disc
  • PROCEED(tm) Ventral Patch
  • Prodisc-C
  • Prodisc-L
  • PROLENE Polypropylene Hernia System (PHS)
  • Rebound HRD(R) (Hernia Repair Device)
  • SynCardia Total Artificial Heart
  • Total artificial (replacement) heart
  • ULTRAPRO Hernia System (UHS)
  • ULTRAPRO Partially Absorbable Lightweight Mesh
  • ULTRAPRO Plug
  • V-Wave Interatrial Shunt System
  • Ventrio(tm) Hernia Patch
  • Zimmer(R) NexGen(R) LPS Mobile Bearing Knee
  • Zimmer(R) NexGen(R) LPS-Flex Mobile Knee
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 04104J4 — 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 J Synthetic Substitute
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.