CPT 35216 Thoracic Vessel Repair Reimbursement | OpenPayer

Summary & Overview

CPT 35216: Open Thoracic Vessel Repair Without Cardiopulmonary Bypass

CPT code 35216 denotes an open thoracic vascular repair in which the surgeon accesses the chest through an appropriate thoracic incision to repair a ruptured vessel without employing cardiopulmonary bypass. This procedure represents a high-acuity, operative intervention for thoracic vascular injury or rupture and carries implications for surgical staffing, facility preparedness, and payer authorization policies at a national scale. Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for this code, typical settings where the service is delivered, and the types of benchmarks and policy issues commonly associated with high-acuity thoracic vascular procedures. The publication outlines expected coding considerations, common modifiers used with operative procedural codes, and payer coverage patterns where available. It also summarizes implications for claims submission and documentation practices and highlights areas where policy updates or payer-specific rules can affect reimbursement and prior authorization. Data not available in the input is identified where necessary.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35216CPTthoracic surgeryvascular repairopen repairoperative procedurecardiopulmonary bypass not usedhospital inpatientsurgical coding

Billing Code Overview

CPT code 35216 describes a surgical procedure in which the surgeon makes an appropriate incision into the thorax to repair a ruptured vessel without the use of cardiopulmonary bypass. The procedure involves direct open repair of a thoracic vascular injury or rupture and is performed through a thoracic incision chosen based on the site of the injured vessel.

Service type: Open thoracic vascular repair without cardiopulmonary bypass
Typical site of service: Operating room in an acute care hospital or other facility capable of thoracic surgery

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting emergently to the emergency department with acute chest or back pain, hypotension, and signs of intrathoracic hemorrhage after blunt chest trauma or from a ruptured intrathoracic vessel (for example, traumatic injury to an intercostal artery or rupture of a thoracic aortic branch). Initial evaluation includes primary survey, chest radiograph and focused CT angiography of the chest when the patient is hemodynamically stable. In unstable patients, the surgical team proceeds directly to the operating room for thoracotomy. Under general anesthesia, the surgeon selects an incision (anterolateral thoracotomy, posterolateral thoracotomy, or median sternotomy) based on vessel location, obtains proximal and distal vascular control, and repairs the ruptured intrathoracic vessel without initiating cardiopulmonary bypass. Postoperative care occurs in the intensive care unit with hemodynamic monitoring, blood product management, and serial imaging as indicated. Typical site of service is the hospital operating room; service type is an emergent or urgent open thoracic vascular repair without cardiopulmonary bypass (operative surgical service).

Coding Specifications

The following modifiers are the most clinically relevant for 35216 and indicate common billing adjustments, circumstances, and provider attributes.

Modifier	Description	When to Use
`22`

CPT 35276: Intrathoracic Blood Vessel Repair with Non‑Venous Graft, No Bypass

CPT-35251-INTRA-ABDOMINAL-VESSEL-REPAIR-VEIN-GRAFT

CPT 35251: Intra-abdominal Vessel Repair with Vein Graft

CPT-35231-NECK-VESSEL-REPAIR-WITH-VEIN-GRAFT

CPT 35231: Repair of Neck Blood Vessel with Vein Graft

CPT-35221-ABDOMINAL-VESSEL-REPAIR

CPT 35221: Abdominal Blood Vessel Repair

CPT-35286-LOWER-EXTREMITY-NON-VENOUS-GRAFT-REPAIR

CPT 35286: Lower Extremity Blood Vessel Repair with Non‑Venous Graft

CPT-35246-INTRATHORACIC-VASCULAR-REPAIR-VEIN-GRAFT-NO-BYPASS

CPT 35246: Intrathoracic Blood Vessel Repair with Vein Graft, No Bypass

CPT-35236-UPPER-EXTREMITY-ARTERIAL-REPAIR-WITH-VEIN-GRAFT

CPT 35236: Upper-Extremity Arterial Repair with Vein Graft

CPT-35256-LOWER-EXTREMITY-ARTERIAL-REPAIR-WITH-VEIN-GRAFT

CPT 35256: Lower Extremity Blood Vessel Repair with Vein Graft

CPT-35206-UPPER-EXTREMITY-VASCULAR-REPAIR

CPT 35206: Upper Extremity Vascular Repair

CPT-35271-INTRATHORACIC-VESSEL-REPAIR-NONVENOUS-GRAFT-BYPASS

CPT 35271: Intrathoracic Vessel Repair with Non‑venous Graft and Bypass

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Taxonomy Code	Specialty	Notes
`332800000X`	Thoracic Surgery	Thoracic or cardiothoracic surgeons commonly perform open thoracic vascular repairs without bypass.
`2085C0003X`	Vascular Surgery	Vascular surgeons manage traumatic or nontraumatic intrathoracic vessel repairs.
`207T00000X`	General Surgery	General surgeons with trauma specialization perform emergent thoracotomies and repairs.
`2086S0122X`	Trauma Surgery	Trauma surgeons frequently perform emergent thoracic vascular repairs in blunt or penetrating trauma.
`221H00000X`	Critical Care Medicine	Intensivists are involved in perioperative and postoperative management in the ICU.

Related Diagnoses

The following ICD-10 codes are commonly associated with 35216 in clinical practice.

ICD-10 Code	Description	Clinical Relevance
`S27.1`	Traumatic rupture of thoracic organ	Represents traumatic intrathoracic vascular or organ rupture requiring emergent repair.
`S25.1`	Injury of thoracic aorta	Thoracic aortic injury or rupture may necessitate open repair without bypass depending on location and stability.
`S25.0`	Injury of heart	Cardiac or pericardial injuries may accompany thoracic vascular rupture and affect surgical approach.
`I71.1`	Thoracic aortic aneurysm, ruptured	Rupture of a thoracic aneurysm can require emergent open repair without cardiopulmonary bypass in select cases.
`I97.8`	Other intraoperative and postprocedural complications and disorders of circulatory system	Used for complications related to vascular repair procedures.

Related CPT Codes

The following CPT codes are commonly performed before, alongside, or after an open thoracic vessel repair without cardiopulmonary bypass.

CPT Code	Description	Relationship to This Procedure
`32100`	Thoracotomy, exploration, with or without pleural drainage; without chest tube insertion	May be used for initial thoracic exploration prior to vascular repair when no chest tube is placed at that time.
`32120`	Thoracotomy, with exploration and control or resection of bleeding source; with chest tube or other drainage	Used when the exploration includes control of bleeding and placement of drainage after repair.
`99100`	Anesthesia complicated by emergency conditions (listed for reference — note: anesthesia codes are managed separately)	Reflects emergency anesthesia considerations accompanying emergent `35216` repairs; billed per anesthesia guidelines.
`35820`	Repair, injury of thoracic aorta; without cardiopulmonary bypass	Related when repair of aortic branch or intrathoracic arterial injury is required without bypass techniques.
`32551`	Tube thoracostomy, includes connection to drainage system (e.g., chest tube)	May be performed preoperatively or postoperatively for pleural drainage in association with thoracic vascular repair.

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