Summary & Overview
CPT 35363: Removal of Thrombus and Plaque from Aortoiliofemoral Artery
CPT code 35363 denotes a surgical vascular procedure to remove thrombus and atherosclerotic plaque from the combined aortoiliofemoral arterial segment. This code captures complex arterial reconstruction work focused on restoring flow in major lower-extremity inflow vessels and is relevant to hospitals, vascular surgery practices, and payers managing high-acuity vascular care. Nationally, procedures on the aortoiliofemoral artery carry significant clinical and resource implications because they address limb- and life-threatening ischemia and frequently involve inpatient care and multidisciplinary teams.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise account of the clinical context for the procedure, common sites of service, and the payer landscape covered in the analysis. The publication also summarizes benchmarks and reimbursement considerations, outlines typical coding and billing considerations, and situates the procedure within broader policy and clinical priorities such as vascular access, limb salvage, and management of atherosclerotic disease. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 35363 describes a surgical procedure in which the provider removes thrombus and plaques from the combined aortoiliofemoral artery. The service involves surgical thrombectomy and endarterectomy-type techniques directed at the aortoiliofemoral arterial segment to restore arterial patency and blood flow.
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Service type: Surgical vascular procedure
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Typical site of service: Hospital operating room or other inpatient/outpatient surgical setting
Clinical & Coding Specifications
Clinical Context
A typical patient is an older adult with symptomatic peripheral arterial disease presenting with acute or chronic limb ischemia, claudication, rest pain, or nonhealing ischemic ulcers. Imaging (CT angiography or conventional angiography) demonstrates extensive thrombus and atherosclerotic plaque involving the aortoiliac and common femoral/proximal femoral arterial segments. The vascular surgery or interventional radiology team schedules an open or hybrid arterial thrombectomy and plaque removal of the combined aortoiliofemoral segment under general or regional anesthesia.
The clinical workflow includes preoperative assessment (vascular exam, ankle-brachial indices, cardiac risk evaluation), informed consent, perioperative antibiotics, imaging review in the operating suite, arterial exposure (usually via a midline abdominal/femoral incision or endovascular access for hybrid cases), Fogarty catheter thrombectomy and plaque excision or endarterectomy as indicated, intraoperative angiography to confirm flow restoration, possible patch angioplasty or bypass grafting if needed, hemostasis, and postoperative monitoring in a step-down or intensive care setting. Postoperative care includes anticoagulation management, vascular examinations, wound care, and imaging follow-up as clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or intensity substantially exceeds typical for due to extensive disease or operative complexity. |