Summary & Overview
CPT 35321: Removal of Thrombus and Plaque from Axillary or Brachial Artery
CPT code 35321 identifies a vascular surgical procedure to remove thrombus and atherosclerotic plaque from the axillary or brachial artery. This procedure is relevant for patients with upper-extremity arterial occlusion, ischemia, or embolic disease that compromise perfusion and limb function. Nationally, accurate coding of this procedure matters for clinical documentation, surgical quality tracking, and payer reimbursement alignment for vascular surgery services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of coding intent and clinical context, typical sites of service, and payer coverage considerations. Readers will find benchmarks where available, relevant policy and coverage highlights, and clinical context to inform coding and billing practices.
The report summarizes typical utilization scenarios for upper-extremity arterial thrombectomy/endarterectomy, outlines common billing considerations, and flags areas where authorization, inpatient-versus-outpatient status, and clinical documentation can affect coverage and payment. Data not provided in the input are noted as unavailable; the focus remains on clarifying clinical description, service setting, and the primary payer landscape for CPT code 35321.
Billing Code Overview
CPT code 35321 describes a surgical procedure in which the provider removes thrombus and plaques from an axillary or brachial artery. This procedure is a form of arterial thrombectomy/endarterectomy focused on the upper-extremity arterial segments.
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Service type: Surgical vascular procedure (open or direct arterial thrombectomy/endarterectomy)
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Typical site of service: Hospital operating room or inpatient surgical suite, and may also be performed in an outpatient surgical center when clinically appropriate
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with a history of peripheral arterial disease and poorly controlled diabetes presents with acute onset of worsening right upper extremity claudication, coolness, pallor, and diminished radial pulse. Diagnostic arterial duplex and CT angiography demonstrate an occlusive thrombus with superimposed atherosclerotic plaque in the right brachial artery with compromised distal perfusion. Vascular surgery evaluates the patient in the hospital and schedules an open embolectomy/thrombectomy of the brachial artery with removal of thrombus and plaque under general anesthesia. The typical clinical workflow includes preoperative assessment and consent, intraoperative vascular exposure of the axillary or brachial artery, arteriotomy, manual or instrument thrombus and plaque removal, possible intraoperative angiography or completion duplex to confirm flow, arterial repair or patch angioplasty as indicated, postoperative monitoring in a recovery unit, anticoagulation management, and discharge planning with vascular follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician interpretation component when separate technical component exists (rare for open arterial thrombectomy but applicable if imaging interpretation billed separately). |
53 |