Summary & Overview
CPT 35022: Open Repair of Subclavian or Innominate Artery Aneurysm
CPT code 35022 denotes open surgical repair of a ruptured aneurysm in the subclavian or innominate artery, involving direct repair or graft placement. This code captures a high-acuity vascular procedure with significant implications for operative resource use, inpatient care, and post-operative monitoring. Nationally, accurate coding for complex vascular repairs influences hospital billing, quality measurement, and reimbursement for trauma and vascular surgery services.
Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise account of the clinical context for the procedure, the expected service setting, and the types of benchmarks and policy levers typically relevant to high-acuity vascular surgery codes. The publication outlines common payer coverage considerations, utilization benchmarks where available, and coding nuances that affect hospital billing and DRG assignment.
This summary equips clinicians, coding professionals, and policy analysts with the clinical framing of CPT code 35022, the payer landscape covered in the analysis, and the topics addressed in detail: coding description, service setting, payer coverage trends, and implications for hospital operations and quality measurement. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 35022 describes a surgical procedure in which a provider makes an incision in the chest to access a ruptured aneurysm of the subclavian or innominate artery, then performs direct repair or places a graft at the site of repair. This represents an open vascular repair of a central upper-extremity great vessel aneurysm.
Service type: Open vascular surgical repair
Typical site of service: Inpatient hospital operating room or other acute care surgical setting
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old male who presents to the emergency department with sudden onset chest pain, dyspnea, hypotension, and pulsatile supraclavicular swelling after a history of chronic hypertension and atherosclerotic disease. Imaging (contrast CT angiography) demonstrates a ruptured aneurysm of the right subclavian artery with active extravasation and mediastinal hematoma. The vascular surgery and cardiothoracic surgery teams are consulted. The clinical workflow includes triage and hemodynamic stabilization in the ED, urgent cross-sectional imaging, blood product preparation, informed consent for emergent open repair, general endotracheal anesthesia, a median sternotomy or thoracotomy to obtain proximal and distal control, direct arterial repair or interposition graft placement, intraoperative hemostasis verification, postoperative ICU-level monitoring, and follow-up vascular imaging.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or complexity substantially exceeds typical for 35022 (extensive dissection, prolonged operative time). |
23 |