Summary & Overview
CPT 35246: Intrathoracic Blood Vessel Repair with Vein Graft, No Bypass
CPT code 35246 denotes surgical repair of an abnormal or injured intrathoracic blood vessel using a vein graft without cardiopulmonary bypass. This high-acuity procedure is performed in the operating room, typically during inpatient hospital encounters, and addresses life- or limb-threatening intrathoracic vascular injuries or pathologies. Nationally, accurate coding of procedures like 35246 affects quality measurement, claims adjudication, and resource allocation for cardiothoracic and vascular surgical services.
Key payers in the scope of typical coverage and benchmarking include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and billing implications for 35246, followed by benchmark considerations and common payer policies where available. The publication will cover coding definitions, typical site of service, and the clinical scenarios that justify this procedure, and will indicate where input data is not available.
This analysis is intended for a national audience of coding professionals, revenue cycle staff, and clinical leaders seeking clarity on the clinical description and billing context of CPT code 35246. Data not available in the input will be noted explicitly in the relevant sections.
Billing Code Overview
CPT code 35246 describes a surgical repair of an abnormal or injured intrathoracic blood vessel using a vein graft performed without cardiopulmonary bypass. This procedure involves vascular reconstruction inside the thoracic cavity and is typically undertaken to restore vessel integrity and blood flow after trauma, injury, or disease affecting intrathoracic arteries or veins.
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Service type: Surgical vascular repair with vein graft (open intrathoracic vascular surgery)
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Typical site of service: Inpatient operating room or specialized surgical suite within a hospital setting
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old male presenting with progressive left-sided chest pain, shortness of breath, and imaging showing pseudoaneurysm of the left intrathoracic subclavian artery following prior trauma. The vascular surgery team evaluates him in the hospital, obtains preoperative CT angiography, and determines the lesion is accessible without cardiopulmonary bypass. The operative plan is surgical repair of the intrathoracic artery using an autologous or prosthetic vein graft under general anesthesia via a thoracotomy or supraclavicular approach. Intraoperative steps include vessel exposure, proximal and distal control, excision or patch repair of the damaged segment, interposition vein graft placement, and hemostasis. Postoperative care includes intensive monitoring for hemodynamic stability, chest tube management if placed, pain control, anticoagulation management per protocol, vascular imaging to confirm graft patency, and discharge planning with wound care and scheduled vascular follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard billing when no other modifier applies |
11 | Principal physician of record |