Summary & Overview
CPT 35331: Removal of Thrombus and Plaque from Abdominal Aorta
CPT code 35331 denotes an open surgical removal of thrombus and atherosclerotic plaque from the abdominal aorta. This procedure is clinically significant for patients with large-vessel aortoiliac occlusive disease or acute aortic thrombosis, where restoration of aortic patency can be limb- and life-saving. Nationally, coding and reimbursement for major vascular procedures affect hospital resource utilization, surgical quality measurement, and care pathways for complex vascular disease.
This publication covers payment and policy perspectives for major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how 35331 is defined clinically and operationally, compare payer coverage considerations, and review common billing and documentation issues that influence claim adjudication. The report also summarizes relevant clinical context for appropriate use and expected settings of care. Where payer-specific benchmark data or policy updates are not present in the input, the text notes that Data not available in the input.
Billing Code Overview
CPT code 35331 describes a surgical procedure in which the provider removes thrombus and atherosclerotic plaques from the abdominal aorta. This procedure is a form of open aortic thrombectomy/endarterectomy intended to restore arterial lumen patency and improve distal blood flow.
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Service type: Open vascular surgical procedure
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Typical site of service: Hospital operating room or inpatient surgical suite
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with symptomatic aortoiliac atherosclerotic disease presenting with progressive lower extremity claudication, rest pain, or acute limb ischemia due to thrombus and plaque burden in the abdominal aorta. The patient often has risk factors such as smoking, diabetes mellitus, hypertension, hyperlipidemia, and peripheral arterial disease. Initial evaluation includes history, physical exam with vascular assessment, ankle-brachial index, arterial duplex ultrasound, and cross-sectional imaging with CT angiography or MR angiography to define the aortic lesion and distal runoff.
Indications for the procedure include significant aortic thrombus or plaque causing flow-limiting stenosis or embolic events where endarterectomy or thrombectomy of the abdominal aorta is required. The clinical workflow typically involves preoperative cardiovascular risk assessment, informed consent, preoperative labs and crossmatch if needed, and optimization of antiplatelet and anticoagulation therapy. The procedure is performed in an operating room or endovascular hybrid suite under general or regional anesthesia. Intraoperative steps may include surgical exposure of the abdominal aorta, arteriotomy, removal of thrombus and atheromatous plaque (arterial thrombectomy/endarterectomy), repair of the arteriotomy with patch angioplasty or primary closure, and assessment of distal pulses or completion angiography. Postoperative care includes monitoring in a recovery unit or intensive care setting, limb perfusion checks, anticoagulation or antiplatelet management, wound care, and follow-up imaging to ensure vessel patency and healing.
Coding Specifications
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