Summary & Overview
CPT 35390: Reoperative Carotid Thrombus Removal After Endarterectomy
CPT code 35390 denotes a reoperation to remove thrombus from a carotid artery through a neck incision performed more than one month after an initial thromboendarterectomy on the same vessel. This code captures a specific reintervention for thrombotic complications following carotid endarterectomy and is relevant where carotid artery patency and stroke prevention are clinical priorities. Nationally, use of this code informs surgical quality measurement, post-endarterectomy complication tracking, and procedural utilization monitoring.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise overview of the clinical context and service setting for 35390, plus benchmarking and policy-relevant considerations: typical sites of service and procedural classification, common payer coverage patterns and coding considerations, and how the code fits into surgical care pathways after carotid thromboendarterectomy. The publication highlights where data are available and notes missing input elements when applicable. It is intended for clinicians, coding professionals, and policy analysts seeking a national-level briefing on this specific vascular reoperation code.
Billing Code Overview
CPT code 35390 describes a surgical reoperation to remove thrombus from a carotid artery through a neck incision performed more than one month after an initial thromboendarterectomy on the same vessel. This procedure is a vascular surgery intervention addressing recurrent or residual thrombus formation following a prior carotid thromboendarterectomy.
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Service type: Reoperative carotid thrombus removal (surgical vascular procedure)
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Typical site of service: Inpatient or outpatient hospital operating room, or ambulatory surgical center, depending on clinical status and facility capabilities.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old male with a prior carotid endarterectomy performed more than one month earlier who presents with progressive ipsilateral neurologic symptoms (transient ischemic attacks, amaurosis fugax, or focal weakness) or with imaging-confirmed recurrent thrombus or stenosis at the surgical site. The clinical workflow begins with neurologic assessment and vascular imaging (duplex ultrasound, CTA or MRA) confirming thrombus in the previously operated carotid artery. The patient is evaluated by the vascular surgery team and cleared for reoperation; perioperative optimization includes antiplatelet/anticoagulation management, cardiopulmonary risk assessment, and informed consent discussing increased reoperation risks. In the operating room the surgeon returns to the previous neck incision, performs exposure of the carotid artery, removes organized thrombus or recurrent intimal flap, and secures the artery (possible patch angioplasty or revision). Postoperatively the patient is monitored in a step-down or ICU setting for neurologic status, blood pressure control, and anticoagulation/antiplatelet therapy, with follow-up vascular imaging and outpatient neurology/vascular clinic visits for surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Professional component | Use when reporting the physician’s professional service separate from technical components when applicable (rare for this surgical code). |