Summary & Overview

CPT 35251: Intra-abdominal Vessel Repair with Vein Graft

CPT code 35251 denotes surgical repair of an abnormal or injured intra–abdominal blood vessel using a vein graft. This is a complex vascular surgical procedure typically performed in an inpatient hospital operating room and is important nationally for trauma care, vascular surgery practice, and management of intra-abdominal vascular pathology. Accurate coding affects clinical documentation, hospital resource allocation, and payer reimbursement processes for high-acuity surgical services.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, typical sites of service, and the payer mix addressed. The publication also outlines common billing modifiers encountered with high-complexity surgical procedures (input list provided separately) and identifies where input data is not available.

This report provides benchmarks and policy-relevant context for healthcare administrators, billing professionals, and vascular surgery clinicians: expected service setting, clinical rationale for using a vein graft for intra-abdominal vessel repair, and guidance on what documentation elements are commonly required by major payers. Data not available in the input is noted explicitly where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35251CPTvascular surgeryintra-abdominalvein graftsurgical repairinpatient surgery

Billing Code Overview

CPT code 35251 describes repair of an abnormal or injured intra–abdominal blood vessel using a vein graft. This procedure involves surgical reconstruction of intra-abdominal vasculature by harvesting and implanting a vein graft to restore vessel integrity and blood flow.

Service type: Surgical vascular repair using a vein graft
Typical site of service: Inpatient operating room or other acute hospital surgical setting

Clinical & Coding Specifications

Clinical Context

A 62-year-old male presents with progressive abdominal pain, a palpable pulsatile mass, and imaging-confirmed rupture of an intra-abdominal arterial segment (for example, a traumatic or degenerative injury to the superior mesenteric artery or an intra-abdominal iliac artery branch). The vascular surgery team evaluates the patient in the emergency department and obtains CT angiography demonstrating focal arterial disruption with inadequate native vessel tissue for primary repair. The patient is taken urgently to the operating room for open intra-abdominal vascular repair. The operative procedure involves excision of the damaged arterial segment and interposition vein graft placement harvested from the patient’s greater saphenous vein or an autologous conduit, with proximal and distal anastomoses performed under vascular clamps. Intraoperative monitoring, general endotracheal anesthesia, and perioperative anticoagulation are used. Postoperatively the patient is transferred to a monitored bed or intensive care unit for hemodynamic observation and surveillance of bowel perfusion and distal pulses. Typical site of service is an inpatient operating room within an acute care hospital. The service type is open intra-abdominal vascular surgery with autologous vein graft interposition corresponding to 35251.

Coding Specifications

Modifier	Description	When to Use
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of a complex intra-abdominal vascular repair.
`80`	Assistant surgeon	Use when a surgical assistant (physician) participates in the procedure and is reported separately.
`81`	Minimum assistant surgeon	Use when minimal assistant involvement is documented (less than typical assistant role).
`82`	Assistant surgeon (when qualified resident not available)	Use when an assistant surgeon is required and a qualified resident is not available.
`59`	Distinct procedural service	Use when another procedure during the same operative session is separate and not bundled with the vascular repair.
`22`	Increased procedural services	Use when the procedure requires substantially greater resources or time than typical (extensive dissection, contaminated field, unusual complexity).
`52`	Reduced services	Use when the procedure is partially reduced or not fully performed as described (aborted graft placement).
`53`	Discontinued procedure	Use when the operation is started but terminated due to patient instability or other unforeseen intraoperative event.
`76`	Repeat procedure by same physician	Not in provided list; Data not available in the input.
`78`	Return to the operating room for a related procedure during the global period	Use when the patient requires a return to OR for a complication related to the initial vascular repair.
`26`	Professional component	Use if billing is separated where only the professional surgical component is reported (rare for operative CPTs that are global).
`TC`	Technical component	Use if only the technical component is billed (e.g., facility billing for equipment/OR resources) when applicable.
`50`	Bilateral procedure	Use when the same intra-abdominal vascular repair is performed bilaterally (rare for visceral arteries; may apply to bilateral iliac branches).
`59`	Distinct procedural service	Duplicate entry avoided; see above.

Taxonomy Code	Specialty	Notes
`207K00000X`	Vascular Surgery	Primary specialty performing open intra-abdominal vascular repairs.
`2080P0208X`	General Surgery	General surgeons with vascular experience may perform emergent intra-abdominal vascular repairs.
`208D00000X`	Thoracic and Cardiac Surgery	In complex proximal aortic or visceral vessel repairs involving thoracoabdominal exposure, cardiothoracic surgeons may be involved.
`207L00000X`	Surgical Critical Care	Manages perioperative critical care for postoperative hemodynamic and organ perfusion monitoring.
`207SG0000X`	Interventional Radiology	May be involved preoperatively for imaging-guided localization or postoperatively for endovascular adjuncts.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I72.3`	False aneurysm of artery	Pseudoaneurysm or arterial disruption may necessitate excision and vein graft interposition.
`I77.4`	Arteriovenous malformation, acquired	Complex vascular lesions with arterial involvement may require surgical repair with grafting.
`I71.3`	Abdominal aortic aneurysm, ruptured	Rupture or extension involving branch vessels can require intra-abdominal vessel repair with vein graft.
`S35.8XXA`	Injury of other intra-abdominal organs, initial encounter	Traumatic intra-abdominal vascular injury may require emergent graft repair.
`K55.0`	Acute vascular disorders of intestine (mesenteric ischemia)	Mesenteric arterial occlusion or injury leading to ischemia may be managed with revascularization using vein graft.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35566`	Extracranial to intracranial bypass graft; for example, repair for arterial reconstruction — Note: `35566` is a peripheral/upper extremity cerebrovascular code	Data not available in the input.
`35631`	Repair of vascular injury, other than carotid, with vein graft; upper and lower extremity or trunk	Often used for peripheral vascular repairs; may be performed when anatomic site is outside the intra-abdominal cavity.
`36215`	Selective catheter placement, arterial; initial third order or more selective catheter, each vessel	Endovascular angiography performed preoperatively or intraoperatively for vessel localization and planning.
`36147`	Introducer placement, intravascular (e.g., sheath)	Used for intraoperative endovascular adjuncts or angiographic monitoring during the repair.
`35831`	Bypass graft, with vein, graft to femoral-popliteal bypass — description for peripheral bypass	Represents similar technique (vein graft interposition) in peripheral arterial reconstructions; included as analogous procedure.