Summary & Overview

CPT 35082: Open Repair of Ruptured Abdominal Aortic Aneurysm

CPT code 35082 denotes an open surgical repair for a ruptured abdominal aortic aneurysm, involving an abdominal incision and direct repair or graft placement. This procedure represents a high-acuity, life-saving vascular surgery with significant resource use, substantial perioperative risk, and important implications for hospital reimbursement and surgical quality metrics. Nationally, management of ruptured abdominal aortic aneurysm is a critical component of vascular surgery capacity and emergency surgical services.

Key payers considered in analyses typically include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and what to expect in benchmarking and policy discussions: common utilization patterns, facility and provider considerations, and how this service is classified for claims submission. Data not available in the input where specifics are missing.

This summary equips administrators, coding professionals, and policy analysts with a clear understanding of the procedure captured by CPT code 35082, why it matters in national surgical care delivery, and the topics to review further when assessing reimbursement, quality reporting, or capacity planning.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35082CPTvascular-surgeryabdominal-aortic-aneurysmopen-repairemergency-surgeryinpatient-surgery

Billing Code Overview

CPT code 35082 describes an open abdominal procedure in which the surgeon makes an incision into the abdomen to access a ruptured aneurysm of the abdominal aorta and then performs direct repair or places a graft at the repair site. This is an emergency vascular surgical repair focused on controlling hemorrhage and restoring aortic integrity.

Service type: Open surgical repair of ruptured abdominal aortic aneurysm
Typical site of service: Inpatient operating room, typically emergent or urgent surgical setting

Clinical & Coding Specifications

Clinical Context

A typical patient is an older adult, often male, presenting to the emergency department with sudden-onset severe abdominal and back pain, hypotension, and a pulsatile abdominal mass consistent with a ruptured abdominal aortic aneurysm (AAA). Rapid triage includes focused history, physical exam, emergent computed tomography angiography (CTA) of the abdomen if hemodynamically stable, point-of-care ultrasound when unstable, and immediate surgical consultation. The vascular surgery or trauma surgery team prepares for open abdominal exploration. In the operating room under general anesthesia, a midline laparotomy is performed to access the ruptured abdominal aorta. Hemorrhage control is achieved with direct vessel clamping, proximal and distal control, and either primary repair or insertion of a synthetic graft (tube or bifurcated graft) depending on aneurysm anatomy and involvement of iliac vessels. Intraoperative blood transfusion, hemodynamic support, and possible concurrent procedures (e.g., bowel assessment, renal protection measures) are common. Postoperatively the patient is managed in an intensive care unit for hemodynamic stabilization, ventilator support as needed, and monitoring for complications such as renal failure, limb ischemia, graft infection, or rebleeding. Typical coders will assign 35082 for open repair of ruptured abdominal aortic aneurysm when performed via abdominal incision with direct repair or graft placement. Common payors for claims submissions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use
`23`	Unusual Anesthesia	Use when normally local/regional anesthesia is not appropriate and general anesthesia is required for an otherwise minor procedure — rarely applicable but included if anesthesia circumstances meet CMS definition.
`22`	Increased Procedural Services	Use when substantial additional work or operative time beyond usual is documented (e.g., complex repair, extensive bleeding).
`52`	Reduced Services	Use when the procedure is partially reduced or not completed as documented.
`53`	Discontinued Procedure	Use when the procedure is started but halted due to extenuating circumstances.
`62`	Two Surgeons	Use when two surgeons from different specialties perform distinct portions of the procedure (e.g., vascular and general trauma surgeon).
`66`	Surgical Team	Use when a surgical team (multiple qualified surgeons) performs the procedure per payer policy.
`78`	Unplanned Return to OR by Same Physician Following Initial Procedure	Use when the patient returns to the OR for related procedure during the postoperative period.
`79`	(Not in provided list)	Data not available in the input.
`80`	Assistant Surgeon	Use when a surgical assistant (qualified resident or attending) actively assists during the procedure.
`81`	Minimum Assistant Surgeon	Use when a lesser level of assistance is provided and payer recognizes modifier.
`AS`	Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery	Use when an advanced practice clinician assists at surgery and the payer allows reporting.
`QK`	Medical Direction of Two, Three, or Four Assistants	Use when the surgeon medically directs multiple qualified assistants at surgery.
`QX`	Certified Registered Nurse Anesthetist (CRNA) Service	Use when a CRNA furnishes anesthesia services under appropriate supervision.
`QY`	Medical Direction of One CRNA by an Anesthesiologist	Use when an anesthesiologist directs one CRNA for anesthesia services.

Taxonomy Code	Specialty	Notes
`207P00000X`	Vascular Surgery	Primary specialty performing open AAA repair.
`2080P00000X`	General Surgery	Often performs open repair in trauma or emergency settings.
`2086S0122X`	Surgical Critical Care	Manages perioperative and ICU care for ruptured AAA patients.
`208000000X`	General Practice / Trauma Surgery	Trauma surgeons frequently perform emergent exposures and repairs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I71.3`	Abdominal aortic aneurysm, ruptured	Primary indication for open emergent repair coded by `35082`.
`I71.4`	Abdominal aortic aneurysm, without rupture	Relevant as pre-rupture diagnosis; open repair may be performed if anatomy precludes endovascular approach.
`I71.9`	Aortic aneurysm, unspecified site, without rupture	May be used if specificity is not documented; less ideal for coding `35082`.
`I71.2`	Thoracoabdominal aortic aneurysm, ruptured	If aneurysm extends into thoracoabdominal aorta, necessitating more extensive repair.
`R57.0`	Cardiogenic shock	May be present on arrival with severe hemodynamic compromise from hemorrhage; relevant for risk adjustment and medical necessity.
`I97.0`	Postprocedural hemorrhage and hematoma of a circulatory system organ or structure	Postoperative complication code used if hemorrhage occurs after AAA repair.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`34800`	Exploratory thoracotomy with cardiopulmonary bypass, not otherwise specified	May be performed when thoracoabdominal extension or control is required (rare adjunct).
`35800`	Aortic thrombectomy; with or without embolectomy of iliac or femoral arteries	Used when thromboembolic complications of aneurysm require removal during the repair.
`36245`	Selective catheter placement, visceral branch, aorta	Used preoperatively or intraoperatively for angiographic assessment or embolization of bleeding branches when endovascular adjuncts are needed.
`36011`	Introduction of non-tunneled centrally inserted central venous catheter, age 5 years or older	Commonly placed for massive transfusion and central venous access during resuscitation.
`36415`	Collection of venous blood by venipuncture	Routine perioperative laboratory monitoring (basic service often bundled).