Summary & Overview
CPT 35092: Open Repair of Ruptured Abdominal Aortic Aneurysm
CPT code 35092 denotes open surgical repair of a ruptured abdominal aortic aneurysm with direct repair or graft placement involving visceral vessels. This high-acuity operative code represents a life‑saving vascular procedure typically performed emergently in an inpatient operating room. Nationally, codes for open aortic repair are central to surgical, hospital, and payer workflows because they carry substantial clinical risk, resource use, and implications for coverage and reimbursement.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise synthesis of the code’s clinical context, common payment and billing considerations, and benchmark framing for major payers. The publication also outlines service-line classification and expected site-of-service patterns for use in clinical billing operations and policy review.
This summary provides operational clarity for revenue cycle teams, clinical leaders, and policy analysts seeking to understand where CPT code 35092 fits within vascular surgery coding, payment planning, and inpatient procedural reporting. Data not available in the input is noted where relevant in downstream sections.
Billing Code Overview
CPT code 35092 describes an open abdominal procedure in which the surgeon makes an incision to access a ruptured aneurysm of the abdominal aorta and visceral vessels, then performs direct repair or places a graft at the repair site. This is a major vascular surgical repair procedure addressing life-threatening aortic rupture involving visceral branches.
Service type: Open surgical vascular repair
Typical site of service: Inpatient operating room
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting emergently with sudden onset severe abdominal and back pain, hypotension, and a pulsatile abdominal mass consistent with a ruptured abdominal aortic aneurysm (AAA). After rapid triage and focused imaging (typically contrast-enhanced CT angiography if the patient is hemodynamically stable), the vascular surgery team determines the need for urgent open surgical repair. The clinical workflow includes rapid resuscitation in the emergency department, activation of the operating room and blood bank, general anesthesia with arterial and central venous access, midline laparotomy or retroperitoneal exposure of the abdominal aorta, direct control of proximal and distal vessels, repair of the rupture by primary suture or placement of an interposition graft (synthetic or autologous), hemostasis, and layered abdominal closure. Postoperatively, the patient is managed in an intensive care unit for hemodynamic support, ventilator management if needed, and monitoring for complications such as renal dysfunction, limb ischemia, or infection. Typical documentation includes indication (ruptured AAA), operative findings, type and size of graft if used, blood product use, procedure duration, personnel involved, and any intraoperative complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when intraoperative complexity or extended work significantly increases over the typical service (document increased work and time). |