Summary & Overview

CPT 35400: Angioscopic Inspection of Blood Vessel

CPT code 35400 denotes intraoperative angioscopic inspection of a blood vessel performed at the same encounter as another surgical procedure. Nationally, this code captures an adjunct visualization service used by vascular and endovascular surgical teams to assess vessel lumen, grafts, or anastomoses during operative care. Accurate coding for this adjunctive service matters for clinical documentation, perioperative workflow clarity, and consistent billing across commercial and government payers.

Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how those payers typically handle adjunct intraoperative services and highlights common billing considerations. Readers will find concise benchmarks and guidance on common modifiers from available input, a clinical context describing when angioscopic inspection is used during surgery, and notes on typical sites of service.

This summary offers a national perspective on the code’s clinical purpose, payer landscape, and the types of information clinicians and billing teams should track when reporting CPT code 35400. Data not provided in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35400CPTangioscopyvascular surgeryintraoperativeendoscopyoperating roomsurgical adjunct

Billing Code Overview

CPT code 35400 describes the use of an angioscope to inspect the interior of a blood vessel when that visualization is performed during the same encounter as another surgical procedure. The service type is an intraoperative endoscopic vascular inspection performed adjunctively to a primary surgical procedure. The typical site of service is an operating room or other procedural suite where vascular surgery or related invasive procedures are performed.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a history of peripheral arterial disease and worsening claudication is scheduled for lower extremity vascular surgery. In the operating room, the vascular surgeon performs open femoral-popliteal bypass for critical limb ischemia. During the same encounter the surgeon uses an angioscope to inspect the lumen of the bypass graft and native vessel segments to verify graft patency and locate residual thrombus or intimal defects. The workflow includes preoperative vascular imaging review, induction of anesthesia in the OR (or vascular lab for hybrid cases), sterile field setup, performance of the primary surgical revascularization, insertion of the angioscope, intraluminal visualization and documentation of findings, any immediate endovascular maneuvers if indicated, and operative note documentation specifying use of the angioscope and findings.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing for the physician’s professional portion separate from technical services (rare for intraoperative use).
`50`	Bilateral procedure	When the angioscopic inspection is performed bilaterally in the same operative session.

Taxonomy Code	Specialty	Notes
208000000X	Vascular Surgery	Primary specialty that performs open and endovascular vascular procedures.
2086S0123X	Interventional Cardiology	Performs intravascular visualization in hybrid arterial procedures when consulted.
207K00000X	General Surgery	May perform peripheral vascular procedures with angioscopic assistance.
207L00000X	Thoracic and Cardiovascular Surgery	Performs complex arterial reconstructions and graft evaluations.

ICD-10 Code	Description	Clinical Relevance
`I70.23`	Atherosclerosis of native arteries of the extremities, bilateral claudication	Peripheral arterial disease causing ischemia where angioscopy may be used intraoperatively to assess vessels.
`I70.21`	Atherosclerosis of native arteries of the extremities with intermittent claudication, right leg	Localizes disease prompting surgical revascularization and intraoperative luminal inspection.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Acute embolic/thrombotic events where angioscopy helps identify thrombus and guide thrombectomy.
I96	Gangrene, not elsewhere classified	Severe ischemia requiring revascularization; angioscopy used to confirm flow restoration (note: code written without backticks per input rules)
`Z95.2`	Presence of prosthetic heart valve	Not directly related — included in error prevention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35400`	Introduction of an angioscope into a blood vessel for inspection performed at the same encounter as another surgical procedure	Primary code describing intraoperative angioscopic inspection performed in conjunction with another surgical procedure.
`35566`	Open repair of femoral artery aneurysm or interposition graft (example)	May be the principal vascular surgical procedure during which angioscopy is performed to inspect graft patency.
`35301`	Thrombectomy, open, with or without embolectomy; femoral, popliteal, or tibial artery	Angioscopy can be used adjunctively to identify thrombus location during open thrombectomy.
`37220`	Revascularization, endovascular, open or percutaneous, for peripheral arterial disease, initial; iliac artery	Used in hybrid cases where endovascular revascularization complements open surgery and angioscopy documents luminal results.
`36215`	Selective catheter placement, arterial system (example for diagnostic angiography)	Pre- or intraoperative angiography commonly performed in conjunction with angioscopy to correlate findings.

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