Ask Dr. Z

My understanding of code 33877 is that carrel patches and reimplantations are included. In the case I am asking about, the provider did 33877 with no reimplantation of visceral vessels. Instead, he used a trifurcated graft and added an additional limb to this graft. He then ligated the celiac, mesenteric, right renal, and left renal arteries. He then used the graft for an antegrade bypass to the celiac, SMA, and right/left renal arteries from the aortic graft. Can I bill the four bypass grafts (35631) in addition to 33877, or would you consider this included since no patches/reimplantations were done? If they are separately billable, would you report code 35631 x 4 or use an unlisted code?