Summary & Overview
CPT 35189: Repair of Acquired or Traumatic Arteriovenous Fistula
CPT code 35189 denotes surgical repair of an acquired or traumatic arteriovenous fistula accessed via an incision in the thorax or abdomen. This procedure is relevant nationally for vascular and thoracic surgeons, hospital surgical services, and payers that manage complex vascular repairs. It is typically performed in an operating room setting, either in an inpatient admission or in an ambulatory surgical center for selected patients.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context for thoracic or abdominal arteriovenous fistula repair, expected sites of service, common billing modifiers associated with surgical services, and an outline of where benchmarking and policy updates commonly affect coverage and reimbursement for complex vascular procedures. The summary highlights operational considerations for coding and billing this surgical service and directs readers to sections with benchmark and policy content where available.
Data not available in the input regarding associated taxonomies, specific ICD-10 diagnoses, related codes, and payer-specific reimbursement rates.
Billing Code Overview
CPT code 35189 describes a surgical procedure in which the provider makes an incision in the thorax or abdomen to approach an acquired or traumatic arteriovenous fistula and performs repair of the fistula. The service type is surgical repair of an arteriovenous fistula. The typical site of service is an inpatient or outpatient surgical setting involving the thoracic or abdominal cavity, such as an operating room in a hospital or ambulatory surgical center.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old male presents to the vascular surgery service with an acquired arteriovenous fistula of the chest wall after penetrating trauma that resulted in a palpable thrill, localized pain, progressive venous engorgement, and a new systolic bruit. Imaging with CT angiography confirms a traumatic arteriovenous communication between a branch of the subclavian artery and adjacent vein within the thorax. The patient is evaluated preoperatively, informed consent is obtained, and standard pre-op labs and crossmatching are completed. In the operating room under general anesthesia, the surgeon makes a thoracic approach incision, isolates the fistulous tract, controls inflow and outflow vessels, and performs open repair of the fistula with direct suture repair and vessel reconstruction as indicated. Postoperative care includes hemodynamic monitoring, wound care, and vascular imaging or duplex ultrasound to confirm fistula closure and limb perfusion prior to discharge. Typical site of service is an inpatient hospital operating room or ambulatory surgery center when clinically appropriate. Typical service type is an open surgical vascular repair procedure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, uncomplicated service | Use when the procedure is the primary, planned service and performed without unusual circumstances |