2025 ICD-10-CM Procedure Code 04130KR

Bypass Hepatic Artery to Lower Artery with Nonautologous Tissue Substitute, Open Approach

ICD-10-PCS Code:: 04130KR
ICD-10-PCS Code for:: Bypass Hepatic Art to Low Art with Nonaut Sub, Open Approac
Is Billable?: Yes - Valid for Submission
Code Navigator:

04130KR is a billable procedure code used to specify the performance of bypass hepatic artery to lower artery with nonautologous tissue substitute, open approach. The code is valid for the year 2025 for the submission of HIPAA-covered transactions. The procedure code involves altering the route of passage of the contents of a tubular body part. Procedure code explanation: 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 coronary artery bypass, colostomy formation

Table of Contents

Code Information
PCS Table
Replacement Code
Diagnostic Related Groups Mapping
Other Similar Codes

04130KR PCS Table

In an PCS table each code is represented by up seven alphanumeric characters, with each character in the table respresenting different aspects of the procedure. In the table provided below, each row represents an individual character and includes information about the character's position, designation, label, and procedure notes. For this PCS table the procedure code is in the medical and surgical section and is part of the lower arteries body system, classified under bypass operation. The applicable bodypart for this procedure code is hepatic artery.

Position	Designation	Character	Label	Procedures Notes
1	Section	0	Medical and Surgical
2	Body System	4	Lower Arteries
3	Operation	1	Bypass	Involves: Altering the route of passage of the contents of a tubular body part Explanation: 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 Includes: Coronary artery bypass, colostomy formation
4	BodyPart	3	Hepatic Artery	Includes: Common hepatic artery Gastroduodenal artery Hepatic artery proper
5	Approach	0	Open	Involves: Cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure
6	Device	K	Nonautologous Tissue Substitute	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) Fish skin Kerecis(R) (GraftGuide) (MariGen) (SurgiBind) (SurgiClose) MIRODERM(tm) Biologic Wound Matrix Piscine skin Tissue bank graft
7	Qualifier	R	Lower Artery

New 2025 ICD-10-PCS Code

04130KR is new to ICD-10-PCS code set for the FY 2025, effective October 1, 2022.

Replacement Code

04130KR replaces the following previously assigned ICD-10-PCS code(s):

04U30KZ - Supplement Hepatic Artery with Nonaut Sub, Open Approach
04U30KZ - Supplement Hepatic Artery with Nonaut Sub, Open Approach
04U30KZ - Supplement Hepatic Artery with Nonaut Sub, Open Approach
04U30KZ - Supplement Hepatic Artery with Nonaut Sub, Open Approach
04U30KZ - Supplement Hepatic Artery with Nonaut Sub, Open Approach
04U30KZ - Supplement Hepatic Artery with Nonaut Sub, Open Approach

04130KR is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together procedures for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on the primary procedure being performed. Once a patient is assigned a particular group, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care associated with a particular procedure. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The procedure code 04130KR is present in the following groups for version MS-DRG V42.0 applicable from 10/01/2024 through 09/30/2025.

MS-DRG	MS-DRG Title	MCD
252	Other Vascular Procedures with MCC	05
253	Other Vascular Procedures with CC	05
254	Other Vascular Procedures without CC/MCC	05
907	Other O.R. Procedures for Injuries with MCC	21
908	Other O.R. Procedures for Injuries with CC	21
909	Other O.R. Procedures for Injuries without CC/MCC	21
957	Other O.R. Procedures for Multiple Significant Trauma with MCC	24
958	Other O.R. Procedures for Multiple Significant Trauma with CC	24
959	Other O.R. Procedures for Multiple Significant Trauma without CC/MCC	24

Other ICD-10-PCS Codes Used for Bypass Hepatic Artery

Filter related codes list:

0413093 Bypass Hepatic Artery to Right Renal Artery with Autologous Venous Tissue, Open Approach
0413094 Bypass Hepatic Artery to Left Renal Artery with Autologous Venous Tissue, Open Approach
0413095 Bypass Hepatic Artery to Bilateral Renal Artery with Autologous Venous Tissue, Open Approach
041309R Bypass Hepatic Artery to Lower Artery with Autologous Venous Tissue, Open Approach
04130A3 Bypass Hepatic Artery to Right Renal Artery with Autologous Arterial Tissue, Open Approach
04130A4 Bypass Hepatic Artery to Left Renal Artery with Autologous Arterial Tissue, Open Approach
04130A5 Bypass Hepatic Artery to Bilateral Renal Artery with Autologous Arterial Tissue, Open Approach
04130AR Bypass Hepatic Artery to Lower Artery with Autologous Arterial Tissue, Open Approach
04130J3 Bypass Hepatic Artery to Right Renal Artery with Synthetic Substitute, Open Approach
04130J4 Bypass Hepatic Artery to Left Renal Artery with Synthetic Substitute, Open Approach
04130J5 Bypass Hepatic Artery to Bilateral Renal Artery with Synthetic Substitute, Open Approach
04130JR Bypass Hepatic Artery to Lower Artery with Synthetic Substitute, Open Approach
04130K3 Bypass Hepatic Artery to Right Renal Artery with Nonautologous Tissue Substitute, Open Approach
04130K4 Bypass Hepatic Artery to Left Renal Artery with Nonautologous Tissue Substitute, Open Approach
04130K5 Bypass Hepatic Artery to Bilateral Renal Artery with Nonautologous Tissue Substitute, Open Approach
04130Z3 Bypass Hepatic Artery to Right Renal Artery, Open Approach
04130Z4 Bypass Hepatic Artery to Left Renal Artery, Open Approach
04130Z5 Bypass Hepatic Artery to Bilateral Renal Artery, Open Approach
04130ZR Bypass Hepatic Artery to Lower Artery, Open Approach
0413493 Bypass Hepatic Artery to Right Renal Artery with Autologous Venous Tissue, Percutaneous Endoscopic Approach
0413494 Bypass Hepatic Artery to Left Renal Artery with Autologous Venous Tissue, Percutaneous Endoscopic Approach
0413495 Bypass Hepatic Artery to Bilateral Renal Artery with Autologous Venous Tissue, Percutaneous Endoscopic Approach
041349R Bypass Hepatic Artery to Lower Artery with Autologous Venous Tissue, Percutaneous Endoscopic Approach
04134A3 Bypass Hepatic Artery to Right Renal Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04134A4 Bypass Hepatic Artery to Left Renal Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04134A5 Bypass Hepatic Artery to Bilateral Renal Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04134AR Bypass Hepatic Artery to Lower Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach
04134J3 Bypass Hepatic Artery to Right Renal Artery with Synthetic Substitute, Percutaneous Endoscopic Approach
04134J4 Bypass Hepatic Artery to Left Renal Artery with Synthetic Substitute, Percutaneous Endoscopic Approach
04134J5 Bypass Hepatic Artery to Bilateral Renal Artery with Synthetic Substitute, Percutaneous Endoscopic Approach
04134JR Bypass Hepatic Artery to Lower Artery with Synthetic Substitute, Percutaneous Endoscopic Approach
04134K3 Bypass Hepatic Artery to Right Renal Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach
04134K4 Bypass Hepatic Artery to Left Renal Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach
04134K5 Bypass Hepatic Artery to Bilateral Renal Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach
04134KR Bypass Hepatic Artery to Lower Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach
04134Z3 Bypass Hepatic Artery to Right Renal Artery, Percutaneous Endoscopic Approach
04134Z4 Bypass Hepatic Artery to Left Renal Artery, Percutaneous Endoscopic Approach
04134Z5 Bypass Hepatic Artery to Bilateral Renal Artery, Percutaneous Endoscopic Approach
04134ZR Bypass Hepatic Artery to Lower Artery, Percutaneous Endoscopic Approach

What is ICD-10-PCS?

The ICD-10 Procedure Coding System (ICD-10-PCS) is a catalog of procedural codes used by medical professionals for hospital inpatient healthcare settings. The Centers for Medicare and Medicaid Services (CMS) maintain the catalog in the U.S. releasing yearly updates. The 2025 ICD-10-PCS codes are to be used for discharges occurring from October 1, 2024 through September 30, 2025.

Each ICD-10-PCS code has a structure of seven alphanumeric characters and contains no decimals. The first character defines the major "section". Depending on the "section" the second through seventh characters mean different things.