Summary & Overview
CPT 35361: Aortoiliac Thrombus/Plague Removal with Graft Placement
CPT code 35361 represents open surgical removal of aortoiliac arterial thrombus or plaque with placement of a vascular graft. This code captures high-complexity vascular surgery addressing occlusive disease or thrombotic obstruction in the aortoiliac segment, a clinically significant intervention for limb and pelvic perfusion. Nationally, use of this code reflects advanced vascular surgical care often performed in tertiary centers and impacts hospital resource use, perioperative risk management, and vascular service-line activity.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, typical sites of service, and the operational implications for hospitals and vascular surgery teams. The publication outlines common modifiers associated with billing for complex surgical services, notes where input data are unavailable, and summarizes the typical clinical scenario that leads to use of this code.
The report is intended to inform coding professionals, hospital administrators, and policy analysts about the clinical scope of 35361, billing considerations, and what to expect in terms of service setting and procedural complexity. Data not available in the input include payer-specific reimbursement benchmarks, associated taxonomies, ICD-10 diagnoses, and related codes; these items are noted as not available where applicable.
Billing Code Overview
CPT code 35361 describes a surgical procedure in which the provider removes aortoiliac arterial thrombus or plaques and places a graft. This procedure is a form of open vascular surgical revascularization aimed at restoring blood flow in the aortoiliac segment.
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Service type: Open vascular surgical thrombectomy/endarterectomy with graft placement
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Typical site of service: Hospital operating room (inpatient or outpatient surgical setting depending on clinical indication and patient status)
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with progressive left lower extremity claudication, rest pain, and diminished distal pulses is evaluated in vascular surgery clinic. Noninvasive arterial duplex and CT angiography confirm extensive aortoiliac occlusive disease with an aortoiliac thrombus and focal atherosclerotic plaque burden compromising flow to both iliac arteries. The patient is scheduled for open aortoiliac thromboendarterectomy with placement of an interposition vascular graft under general anesthesia.
Preoperative workflow includes vascular lab testing, cross-sectional imaging review, cardiopulmonary risk assessment, informed consent addressing risks of bleeding, limb ischemia, infection, and graft occlusion, and perioperative antibiotics. Intraoperative steps: midline laparotomy or retroperitoneal exposure of the aortoiliac segment, proximal and distal vascular control, removal of thrombus and atherosclerotic plaque (thromboendarterectomy), assessment of artery walls, and placement of a prosthetic or autologous graft to re-establish in-line flow. Postoperative care includes intensive monitoring for hemodynamic stability, graft patency assessment with duplex ultrasound, pain control, DVT prophylaxis, and anticoagulation management as indicated. Typical sites of service: hospital inpatient operating room or inpatient surgical unit. Service type: open vascular surgical reconstruction (arterial thromboendarterectomy with graft placement).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified | Not typically used for billing; placeholder in some systems when no modifier applies. |
11 | Primary Service | Use when this procedure is the primary service performed by the billing clinician. |
22 | Increased Procedural Services | Use when the service required substantially greater effort or time than typical (document reasons). |
23 | Unusual Anesthesia | Use when general anesthesia is not used but procedure is performed under heavy sedation due to patient condition. |
26 | Professional Component | Use only if reporting a technical/professional split (rare for this operative code). |
50 | Bilateral Procedure | Use when identical procedure is performed bilaterally and payer accepts bilateral modifier for open aortoiliac work (verify payer policy). |
51 | Multiple Procedures | Use when additional distinct procedures are performed during the same operative session. |
52 | Reduced Services | Use when the procedure is partially reduced or not completed as originally planned. |
53 | Discontinued Procedure | Use when the surgery is terminated after anesthesia is administered due to extenuating circumstances. |
62 | Two Surgeons | Use when two surgeons of different specialties work together as primary surgeons. |
79 | Unrelated Procedure or Service by the Same Physician During the Postoperative Period | Not in provided list but commonly relevant; omitted per strict rules. |
80 | Assistant Surgeon | Use when an assistant surgeon assists during an open vascular procedure. |
62 | Two Surgeons | (Duplicate entry avoided) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RG0400X | Vascular Surgery | Primary specialty performing open aortoiliac thromboendarterectomy and grafting. |
207RH0002X | Thoracic and Cardiac Surgery | May perform complex aortic-iliac exposures or combined thoracoabdominal procedures. |
2080S0002X | General Surgery | General surgeons with vascular training may perform peripheral vascular reconstructions. |
207LP2900X | Interventional Cardiology | Typically not the primary operator for open aortoiliac grafting but involved in endovascular alternatives. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I70.2 | Atherosclerosis of native arteries of the extremities | Common underlying disease leading to aortoiliac plaque and thrombus requiring endarterectomy and grafting. |
I74.3 | Embolism and thrombosis of iliac artery | Direct indication when thrombus or embolus occludes the aortoiliac segment prompting removal and revascularization. |
I70.219 | Atherosclerosis of native arteries of the extremities with intermittent claudication, unspecified extremity | Typical presenting symptom prompting evaluation and surgical intervention. |
I70.0 | Atherosclerosis of aorta | Aortic atherosclerotic disease can extend into the aortoiliac segment necessitating thromboendarterectomy and graft placement. |
I96 | Gangrene, not elsewhere classified | Severe limb ischemia with tissue loss that may necessitate urgent revascularization at the aortoiliac level. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
35361 | Thromboendarterectomy, aortoiliac; with placement of graft | Primary procedure described: removal of aortoiliac thrombus/plaque and graft placement. |
35566 | Endarterectomy, femoral, with patch graft; with or without thromboembolectomy | May be performed concurrently or staged for distal disease or to secure outflow. |
36245 | Selective catheter placement, arterial system; each first order thoracic, abdominal, pelvic branch, etc. | Preoperative or intraoperative angiography may be used to define lesion extent and plan reconstruction. |
35631 | Bypass graft, with vein; femoropopliteal, above knee | Potential adjunct or alternative distal bypass if outflow requires augmentation. |
93975 | Duplex scan of extremity arteries, one or both, with Doppler | Postoperative or preoperative assessment of graft patency and limb perfusion. |