Summary & Overview
CPT 35021: Repair/Graft of Subclavian or Innominate Artery Aneurysm
CPT code 35021 denotes open surgical repair or grafting of an aneurysm or pseudoaneurysm of the subclavian or innominate artery. This code captures major thoracic arterial reconstruction performed through a chest incision and is clinically significant because these procedures address life‑threatening vascular lesions that require complex perioperative care and hospital resources. Nationally, accurate coding for such high‑acuity vascular surgery affects facility classification, resource allocation, and aggregated procedure volumes used in policy and payment discussions.
Key payers covered in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, expected site of service and service type, common billing modifiers and considerations, and guidance on related coding practice areas. The report also summarizes typical payer coverage patterns and benchmarking where available. Policy updates, documentation essentials for surgical repair versus endovascular alternatives, and implications for hospital reimbursement and case mix are outlined to inform coding, billing, and administrative teams.
This national overview is intended for health system coders, billing managers, and clinical leaders seeking a focused reference on coding and administrative context for open repair or grafting of subclavian and innominate artery aneurysms.
Billing Code Overview
CPT code 35021 describes an open surgical procedure in which the provider makes an incision in the chest to access an aneurysm or pseudoaneurysm of the subclavian or innominate artery and then performs direct repair or places a graft at the site of repair. The service involves operative arterial reconstruction or graft placement targeted to major thoracic branch vessels.
Service type: Open vascular surgery — arterial repair/grafting
Typical site of service: Inpatient operating room or other surgical suite in an acute care hospital
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old male presenting with chest pain, localized shoulder swelling, or signs of distal upper-extremity ischemia. Imaging (CT angiography or duplex ultrasound) identifies an aneurysm or pseudoaneurysm of the subclavian or innominate (brachiocephalic) artery with risk for rupture, embolization, or limb-threatening ischemia. The vascular surgery team evaluates comorbidities (cardiac, pulmonary), reviews vascular imaging, and obtains informed consent. In the operating room or hybrid suite under general anesthesia, the surgeon performs a median sternotomy, supraclavicular, or thoracotomy incision to expose the affected subclavian or innominate artery. The procedure includes proximal and distal control, aneurysm sac management, and either direct arterial repair (primary suture repair) or interposition graft placement (vein or prosthetic graft) as indicated by vessel damage and tissue quality. Intraoperative monitoring may include arterial lines, transesophageal echocardiography, and neurophysiologic monitoring when indicated. Postoperative care includes intensive monitoring for bleeding, graft patency assessment with duplex or CT angiography, pain control, anticoagulation management as indicated, and discharge planning with follow-up imaging and vascular clinic visits. Typical sites of service are the operating room in a hospital inpatient or outpatient surgical center and, when complex exposure is required or the patient has hemodynamic instability, inpatient hospitalization with ICU-level monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 |