Summary & Overview
CPT 35351: Iliac Artery Thrombus and Plaque Removal
CPT code 35351 denotes surgical removal of thrombus and atherosclerotic plaque from an iliac artery. Nationally, this procedure is an important vascular intervention to re-establish arterial patency in patients with limb- or organ-threatening ischemia. It carries significance for hospitals, vascular surgeons, and payers because of its clinical urgency, potential for perioperative resource use, and implications for post-procedure monitoring and secondary prevention.
Key payers covered in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, benchmarks that typically accompany procedural coding analyses, and policy-relevant considerations affecting coverage and site-of-service determination. The publication outlines common service settings, expected coding considerations, and areas where payer policies can influence authorization and payment processes.
This summary prepares clinicians, coding professionals, and policy analysts to interpret billing for iliac artery thrombectomy/endarterectomy procedures, compare reimbursement and utilization patterns across major payers, and understand where updates to coding guidance or payer policy may affect clinical and administrative workflows.
Billing Code Overview
CPT code 35351 describes a surgical procedure in which the provider removes thrombus and plaques from an iliac artery. The service is an arterial thrombectomy/endarterectomy targeted to the iliac segment, performed to restore blood flow and reduce ischemic risk.
Service Type: Vascular surgical arterial thrombectomy/endarterectomy
Typical Site of Service: Inpatient or outpatient hospital operating room or vascular surgery suite
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old individual with progressive left lower-extremity claudication and an ankle-brachial index of 0.6 despite conservative therapy. Imaging with CT angiography demonstrates an occlusive thrombus and atherosclerotic plaque burden localized to the left common and/or external iliac artery with hemodynamically significant stenosis. The vascular surgeon schedules an open or hybrid arterial thrombectomy/endarterectomy under general or regional anesthesia in an operating room or vascular suite.
Preoperative workflow includes vascular assessment, medication review (antiplatelet and anticoagulant management), informed consent, and cross-sectional imaging review. Intraoperatively, the surgeon gains proximal and distal control of the iliac artery, performs an arteriotomy, removes thrombus and adherent atheromatous plaque with surgical instruments or thrombectomy catheters, evaluates flow, and performs patch angioplasty or primary closure as indicated. Completion angiography may be performed to confirm revascularization. Postoperative care includes monitoring for limb perfusion, anticoagulation/antiplatelet management, and wound care, typically in a post-anesthesia care unit or step-down setting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician’s professional portion of a service if separate technical component is billed by another entity. |