Summary & Overview
CPT 35103: Open Repair of Ruptured Aortic and Iliac Aneurysm
CPT code 35103 represents an open abdominal and pelvic surgical repair for ruptured aneurysms of the aorta and iliac vessels. This high-acuity vascular procedure is performed emergently in the operating room and carries significant clinical and financial implications due to resource intensity, perioperative risk, and the need for blood products and critical care. Nationally, management of ruptured aortic and iliac aneurysms remains a focal point for trauma, vascular surgery, and inpatient surgical quality programs.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national view of CPT code 35103, including clinical context, typical site-of-service expectations, common billing modifiers (list provided separately), and where available, benchmarking and policy considerations that affect coverage and reimbursement for emergent open vascular repairs. The publication outlines what clinicians and billing professionals need to know about coding and service classification for emergency open repair of ruptured aortic/iliac aneurysms and highlights areas where payers and Medicare policies commonly intersect with clinical practice.
Data not available in the input for payer-specific rates, associated taxonomies, and ICD-10 diagnoses.
Billing Code Overview
CPT code 35103 describes an open surgical procedure in which the surgeon makes an incision into the abdomen and pelvis to access a ruptured aneurysm of the aorta and iliac vessels. The procedure involves direct repair of the vessel or placement of a graft at the site of the rupture.
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Service type: Open vascular surgery for ruptured aortic and iliac aneurysm
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Typical site of service: Inpatient operating room (abdominal/pelvic open surgical setting)
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Clinical & Coding Specifications
Clinical Context
A 72-year-old man presents to the emergency department with sudden-onset severe abdominal and back pain, hypotension, and a pulsatile abdominal mass. A computed tomography angiogram confirms a ruptured infrarenal abdominal aortic aneurysm with extension into the common iliac artery. The vascular surgery team takes the patient emergently to the operating room for open repair. Under general anesthesia, a midline laparotomy is performed to access the retroperitoneum and aortic rupture. The surgeon controls proximal and distal vessels, evacuates hematoma, and performs either direct suture repair or interposition graft placement to exclude the aneurysm and restore perfusion. Intraoperative steps include vascular control, heparinization as indicated, graft selection and anastomosis, and hemostasis. Postoperative care involves transfer to the intensive care unit for hemodynamic monitoring, ventilatory support as needed, serial hematocrits, and surveillance for complications such as bleeding, renal injury, or limb ischemia. Documentation includes operative note with 35103, estimated blood loss, graft type, anastomosis details, laterality if applicable, and any concurrent procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typically required (e.g., extensive repair, massive transfusion, prolonged operative time). |