Summary & Overview

CPT 35091: Open Abdominal Aortic/Visceral Vessel Aneurysm Repair

CPT code 35091 represents an open abdominal vascular procedure to access and repair an aneurysm or pseudoaneurysm of the abdominal aorta or visceral vessels, including direct repair or graft placement. This code captures high-complexity, operative vascular care that is performed in an operating room setting and is a core component of surgical management for abdominal aortic aneurysms and related visceral vessel pathology. Nationally, services billed under this code are significant for resource utilization, surgical risk, and perioperative care coordination.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, typical sites of service, and common billing considerations. The publication summarizes available benchmarks and payer coverage patterns, highlights relevant coding and policy developments affecting payment and authorization, and provides clinical context to aid coding accuracy and documentation alignment. Data not available in the input is identified where applicable.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicare35091CPTvascular surgeryabdominal aortic aneurysmopen repairsurgical codingoperating roomvascular graft

Billing Code Overview

CPT code 35091 describes an open abdominal procedure in which a provider makes an incision into the abdomen to access an aneurysm or pseudoaneurysm of the abdominal aorta or visceral vessels and performs a direct repair or places a graft at the repair site. This procedure is a form of open vascular surgery directed at repairing aneurysmal disease or traumatic/iatrogenic pseudoaneurysms within the abdominal aorta and its visceral branches.

Service type: Open surgical vascular repair
Typical site of service: Inpatient hospital operating room or surgical suite

Clinical & Coding Specifications

Clinical Context

A typical patient is a 68-year-old male with a known infrarenal abdominal aortic aneurysm (AAA) presenting with increasing abdominal/back pain and aortic diameter enlargement on surveillance imaging. After cross-sectional imaging (CT angiography) confirms an enlarging or symptomatic aneurysm not amenable to endovascular repair, the vascular surgery team schedules an open abdominal aortic aneurysm repair. The patient is admitted to the hospital preoperatively for optimization of comorbidities (cardiac clearance, medication management, blood typing and crossmatch). In the operating room under general anesthesia, the surgeon makes an abdominal incision, gains proximal and distal control of the aorta and involved visceral vessels, performs direct repair or places a prosthetic graft, ensures hemostasis, and closes the abdomen. Postoperative care includes ICU monitoring for hemodynamics, renal function, and limb perfusion, pain control, DVT prophylaxis, and wound care. Discharge planning includes follow-up imaging and outpatient vascular surgery clinic visits.

Coding Specifications

Modifier	Description	When to Use
`62`	Two surgeons	Use when two surgeons work together as primary surgeons, both performing distinct portions of the open repair.
`66`	Surgical team complexity	Use for procedures performed by a surgical team when reporting rules require team designation.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as planned.
`53`	Discontinued procedure	Use when the open repair is started but terminated due to extenuating circumstances.
`22`	Increased procedural services	Use when work required is substantially greater than typical (e.g., dense adhesions, hostile abdomen).
`78`	Return to OR for related procedure during postoperative period	Use when the patient returns to the OR for a complication related to the original repair.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period. (Note: `79` is not listed among provided modifiers; not included.)
`73`	Discontinued outpatient hospital/ambulatory surgery center procedure prior to anesthesia induction	Use if the outpatient open repair is canceled before anesthesia induction. (Typically rare for open AAA.)
`74`	Discontinued outpatient after anesthesia induction but before incision	Use if anesthesia is given and the case is stopped before incision. (Note: `74` is not listed among provided modifiers; not included.)
`50`	Bilateral procedure	Use when bilateral simultaneous abdominal visceral vascular repairs are performed and bilateral logic applies.
`62`	Two surgeons	(Already listed — duplicate avoided in billing; included once.)
`11`	Normally scheduled daytime procedure	Use to indicate usual timing when required by specific payors.
`23`	Unusual anesthesia	Use when general anesthesia is contraindicated and an unusual anesthesia technique is used.
`26`	Professional component	Use when reporting professional interpretation components separately (rare for surgical procedure coding).
`53`	Discontinued procedure	(Already listed — duplicates avoided.)

Taxonomy Code	Specialty	Notes
208100000X	Vascular Surgery	Primary specialty performing open aortic and visceral arterial repairs.
207P00000X	General Surgery	General surgeons with vascular training may perform open aortic repairs in some centers.
2080S0124X	Thoracic and Cardiac Surgery	Thoracic/vascular surgeons may be involved for complex aortic reconstructions that extend proximally.
333600000X	Interventional Radiology	Often involved preoperatively for imaging/angiography and in hybrid procedures.
207LG0400X	Trauma Surgery	May perform open repairs emergently for ruptured abdominal aortic aneurysm.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I71.4`	Abdominal aortic aneurysm, without rupture	Common indication for elective open repair when anatomy or patient factors preclude endovascular repair.
`I71.3`	Abdominal aortic aneurysm, ruptured	Emergency indication for open repair; requires immediate operative management.
`I72.3`	Aneurysm of iliac artery	Iliac involvement may require extension of repair or grafting during open aortic procedures.
`I72.8`	Aneurysm of other specified arteries	Relevant when visceral or branch aneurysms accompany aortic aneurysm requiring repair.
`I71.9`	Aortic aneurysm, unspecified	Used when documentation specifies aneurysm but laterality or rupture status is not clearly documented.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35091`	Open repair of abdominal aortic aneurysm or pseudoaneurysm with direct repair or graft placement	Primary procedure description for open abdominal aortic and visceral vessel aneurysm repair.
`34900`	Direct repair of aneurysm, abdominal aorta (without graft)	Alternative technique when direct suture repair is feasible rather than graft placement.
`34802`	Repair of ruptured abdominal aorta; initial procedure, direct suture repair	Used when emergent repair for rupture is performed and documents the specific rupture repair.
`35631`	Replacement, abdominal aorta; with synthetic graft (infrarenal)	Often reported for prosthetic graft placement in open aortic reconstruction (surgeon documents graft type and anatomic extent).
`36147`	Insertion of catheter, arteriovenous, for diagnostic angiography (aorta)	Diagnostic aortography performed intraoperatively or preoperatively to define anatomy and guide repair.