Summary & Overview
CPT 35311: Thoracic Subclavian or Innominate Artery Thrombectomy/Endarterectomy
CPT code 35311 denotes an open thoracic vascular procedure to remove thrombus and plaque from the subclavian or innominate artery through a chest incision. This surgical intervention is used to restore arterial patency in cases of occlusion that threaten upper extremity or cerebrovascular perfusion. Nationally, the code represents a high-acuity operative service with implications for hospital resource use, perioperative risk management, and specialty reimbursement.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical settings of care, and commonly reported modifiers associated with surgical complexity and professional/technical components. The publication also outlines benchmarks for service utilization, typical billing practices, and relevant policy considerations that affect coverage and prior authorization trends for high-risk thoracic vascular surgery.
This summary is intended for clinician billing staff, vascular surgeons, revenue cycle managers, and policy analysts seeking a national-level briefing on coding and billing characteristics for CPT code 35311, including the clinical rationale for the procedure and areas where payer policies commonly intersect with surgical practice.
Billing Code Overview
CPT code 35311 describes a surgical procedure in which the provider removes thrombus and atherosclerotic plaque from a subclavian or innominate artery through an incision in the thorax (chest). This is a vascular surgery procedure intended to restore or improve arterial blood flow by physically extracting occlusive material.
Service Type: Open thoracic vascular thrombectomy/endarterectomy
Typical Site of Service: Operating room or surgical suite in an inpatient or specialized outpatient hospital setting (thoracic/vascular surgery)
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with atherosclerotic disease presents with progressive right upper extremity claudication, diminished brachial pulse, and occasional paresthesia. Noninvasive arterial duplex and CT angiography demonstrate a high-grade proximal right subclavian artery occlusion with thrombotic material and atherosclerotic plaque at the thoracic inlet causing symptomatic ischemia. The vascular surgery team schedules an open thrombectomy/endarterectomy via a supraclavicular and/or thoracic incision for removal of thrombus and atheromatous plaque from the subclavian artery. The patient is admitted preoperatively for cardiovascular risk optimization, undergoes general anesthesia, intraoperative arterial monitoring, and vascular access for possible shunt placement. The procedure involves exposure of the subclavian/innominate artery through a chest or thoracic incision, arteriotomy, removal of thrombus and plaque, possible patch angioplasty or interposition grafting, and completion angiography to confirm flow restoration. Postoperative care includes hemodynamic monitoring, antiplatelet or anticoagulant therapy per protocol, wound care, and follow-up vascular imaging to assess patency and neurologic/limb symptom resolution.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or complexity substantially exceeds usual for 35311 (provide documentation). |