Summary & Overview
CPT 35301: Thromboendarterectomy of Carotid, Vertebral, or Subclavian Arteries
CPT code 35301 represents thromboendarterectomy of the carotid, vertebral, or subclavian arteries performed through a neck incision, often including a patch graft. This complex vascular surgery is a key intervention for patients with arterial occlusion or stenosis, particularly in the carotid artery, and is essential for preventing stroke and other serious complications. The procedure is typically conducted in an inpatient hospital setting due to its complexity and the need for postoperative monitoring.
Major national payers covering this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Understanding coverage policies and reimbursement benchmarks for 35301 is crucial for hospitals, surgical teams, and billing professionals. This publication provides a comprehensive overview of payer coverage, clinical indications, and related coding practices, including common modifiers and associated taxonomies. Readers will gain insights into current policy updates, clinical context, and coding benchmarks relevant to vascular surgery.
Key topics include the clinical rationale for thromboendarterectomy, typical patient diagnoses such as occlusion and stenosis of the carotid artery (I65.21), and related CPT codes for similar vascular interventions. The summary also addresses the importance of accurate coding and documentation to ensure compliance and optimal reimbursement across all major payers.
CPT Code Overview
CPT code 35301 describes a thromboendarterectomy procedure, which involves the surgical removal of a thrombus and endarterectomy, including patch graft if performed, from the carotid, vertebral, or subclavian arteries via a neck incision. This procedure is classified under surgical procedures on arteries and veins and is typically performed in an inpatient hospital setting (Place of Service 21). It is a critical intervention for patients with significant arterial occlusion or stenosis, aiming to restore blood flow and reduce the risk of stroke or other vascular complications.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting with symptoms of cerebral ischemia, such as transient weakness, numbness, or speech difficulties. Diagnostic imaging reveals significant occlusion or stenosis of the right carotid artery, corresponding to ICD-10 code I65.21. The vascular surgeon determines that surgical intervention is necessary to restore blood flow and prevent stroke. The procedure, coded as 35301, is performed in an inpatient hospital setting, where the surgeon accesses the carotid artery via a neck incision, removes the obstructive material (thrombus and plaque), and may place a patch graft to repair the vessel. Postoperative care includes monitoring for neurological changes and vascular patency.
Coding Specifications
Common Modifiers:
-
Modifier
50(Bilateral Procedure): Used if the procedure is performed on both sides (e.g., both carotid arteries). -
Modifier
51(Multiple Procedures): Applied when more than one procedure is performed during the same operative session. -
Modifier
59(Distinct Procedural Service): Indicates a procedure or service that is distinct or independent from other services performed on the same day.
Associated Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
2086S0129X | Vascular Surgery Physician |
208600000X | Surgery Physician |
2086S0127X | Surgical Critical Care Physician |
These taxonomies represent providers specializing in vascular surgery, general surgery, and surgical critical care, all of whom may be involved in the performance or perioperative management of this procedure.
Related Diagnoses
-
I65.21(Occlusion and stenosis of right carotid artery):This diagnosis indicates a narrowing or blockage of the right carotid artery, which is clinically relevant as it is the primary indication for performing a thromboendarterectomy (
35301). The procedure aims to restore blood flow and reduce the risk of stroke in patients with this condition.
Related CPT Codes
| CPT Code | Description | Clinical Relationship |
|---|---|---|
35371 | Thromboendarterectomy, abdominal aorta | Similar procedure performed on the abdominal aorta; alternative site to the carotid, vertebral, or subclavian arteries. |
35450 | Transluminal balloon angioplasty, percutaneous; femoral-popliteal | Minimally invasive alternative for revascularization in femoral-popliteal arteries; not typically performed on carotid arteries. |
37224 | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery | Endovascular or open revascularization for femoral/popliteal arteries; alternative to open thromboendarterectomy. |
36245 | Selective catheter placement, arterial system; each first-order thoracic or brachiocephalic branch, within a vascular family | Used for diagnostic angiography or interventional access prior to surgical or endovascular procedures. |
These codes may be used as alternatives or adjuncts depending on the anatomical site and clinical approach. 36245 is commonly used in conjunction with diagnostic or interventional procedures.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 35301 under Medicare is $1,025.98, while the average commercial rate (BUCA) is $1,469.69. Commercial payers such as UnitedHealth Group and Cigna have notably higher mean rates, at $2,036.65 and $1,890.76 respectively, compared to both Medicare and BUCA.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare exhibits the tightest range at $84.00, indicating relatively consistent reimbursement. In contrast, UnitedHealth Group shows the widest dispersion at $1,204.50, reflecting greater variability in rates. Cigna and Aetna also display substantial ranges, at $1,036.50 and $584.50 respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
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