Summary & Overview
CPT 35182: Repair of Congenital Arteriovenous Fistula, Abdomen or Thorax
CPT code 35182 represents an open surgical approach and repair of a congenital arteriovenous fistula located in the abdomen or thorax. This code captures a specialized vascular procedure that addresses abnormal congenital connections between arterial and venous systems, often requiring operative exposure and direct repair. Nationally, accurate use of this code matters for procedural tracking, clinical outcomes measurement, and appropriate reimbursement for complex vascular surgery.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for congenital arteriovenous fistula repair, expected sites of service, and common coding considerations. The publication outlines benchmarks for utilization patterns where available, summarizes relevant policy and coverage themes that affect authorization and payment, and highlights clinical factors that typically influence site-of-service decisions and complexity of care.
This summary equips clinicians, coding professionals, and hospital administrators with the core facts about CPT code 35182, what it denotes clinically, which major payers are relevant, and what to expect from accompanying sections covering benchmarks, policy updates, and coding guidance. Data not available in the input will be noted in the detailed sections.
Billing Code Overview
CPT code 35182 describes a surgical procedure in which the provider makes an incision to approach a congenital arteriovenous fistula in the abdomen or thorax and performs repair of the fistula. This represents an operative vascular procedure to correct a congenital arteriovenous communication.
-
Service type: Surgical vascular repair
-
Typical site of service: Inpatient operating room or outpatient hospital main operating suite, depending on clinical complexity and patient status
Clinical & Coding Specifications
Clinical Context
A typical patient is an infant or child presenting with signs of a congenital arteriovenous fistula (AVF) in the thorax or abdomen — for example, a newborn with a palpable thrill, continuous murmur, tachycardia, or signs of high-output cardiac failure, or an older child with abdominal bruit, localized pain, or ischemic symptoms. Diagnostic workflow begins with history and physical exam, followed by noninvasive imaging such as Doppler ultrasound and cross-sectional imaging (CT angiography or MR angiography) to define the fistula anatomy, feeding vessels, and surrounding structures. Preoperative evaluation includes cardiology assessment when there is suspected high-output failure, baseline labs, and anesthetic assessment.
Operative workflow: the surgical team obtains informed consent and appropriate preoperative antibiotics if indicated. Under general anesthesia, the surgeon makes an incision to access the congenital arteriovenous fistula in the thorax or abdomen, isolates feeding arteries and draining veins, and performs vascular control. The fistula is repaired by ligation, excision, or vascular reconstruction depending on anatomy and tissue quality. Hemostasis is confirmed and the wound is closed in layers. Postoperative care includes monitoring in a recovery area or pediatric ICU for hemodynamic stability and ventilation needs, imaging follow-up as indicated, and coordination with interventional radiology if staged embolization is required.
Typical site of service: inpatient operating room or pediatric/vascular surgery suite.
Service type: open surgical repair of congenital arteriovenous fistula of the thorax or abdomen.
Coding Specifications
| Modifier | Description | When to Use |
|---|