Summary & Overview
CPT 35131: Open Repair of Iliac Artery Aneurysm or Pseudoaneurysm
CPT code 35131 designates open surgical repair of an iliac artery aneurysm or pseudoaneurysm via an abdominal or retroperitoneal incision, with direct arterial repair or graft placement. This procedure represents a high-acuity vascular surgical service that impacts hospital resource use, surgical scheduling, and perioperative care pathways nationally. The code is relevant for vascular surgery, trauma, and vascular interventional teams managing complex arterial pathology.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on clinical indications and the typical service setting, as well as national payment and utilization benchmarks where available. The publication also highlights coding considerations, common modifiers, and related surgical service lines to inform billing accuracy and administrative review.
This summary provides clinicians, billers, and policy analysts with an overview of the procedure captured by CPT code 35131, the settings in which it is commonly performed, and the payer landscape most relevant to reimbursement and utilization discussions. Data not available in the input is flagged where applicable within the full publication.
Billing Code Overview
CPT code 35131 describes an open surgical procedure to expose and repair an iliac artery aneurysm or pseudoaneurysm through an abdominal or retroperitoneal incision. The provider gains direct access to the affected iliac artery and performs direct repair or placement of a graft at the site of repair.
Service type: Open vascular surgical repair of iliac artery aneurysm/pseudoaneurysm
Typical site of service: Hospital inpatient or hospital outpatient operating room, with access via abdominal or retroperitoneal approach
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with a history of hypertension and peripheral arterial disease presents with intermittent left groin pain and a pulsatile mass on exam. Imaging with CT angiography demonstrates a 3.5 cm left common iliac artery aneurysm with thinning of the arterial wall and contained contrast extravasation suggestive of a pseudoaneurysm. The vascular surgery team plans an open repair via an abdominal or retroperitoneal approach to directly repair the aneurysm and, if necessary, place an interposition graft.
Preoperative workflow includes vascular lab duplex and CT angiography for anatomic planning, medical optimization (blood pressure control, coagulation assessment), informed consent discussing risks of bleeding, infection, and limb ischemia, and surgical scheduling. Intraoperative steps include general anesthesia, abdominal or retroperitoneal incision, proximal and distal control of the iliac artery, evacuation of thrombus if present, direct primary repair or resection with placement of a synthetic or autologous graft, completion angiography as indicated, and closure. Postoperative care includes monitoring for bleeding, graft patency assessment with duplex ultrasound or CTA, pain control, and secondary prevention of atherosclerotic disease.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier indicated / Not used by CMS for claims reporting | Data not typically appended; reserved placeholder in some systems |
| | Emergency/Unplanned Service | Use when the procedure was performed emergently for rupture or symptomatic pseudoaneurysm