CPT 35531 Aorto-Visceral Vein Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35531: Aorto-to-Celiac/Mesenteric Vein Bypass Graft

CPT code 35531 denotes open surgical bypass from the aorta to a celiac or mesenteric artery using a vein graft to bypass an arterial obstruction. This complex vascular procedure addresses mesenteric or celiac ischemia and other visceral arterial occlusive diseases, and it is significant nationally due to its implications for perioperative risk, resource use, and specialty surgical billing. Payers commonly involved in coverage for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find clinical and billing context for CPT code 35531, including the procedure’s role in treating visceral arterial occlusion, typical sites of service, and the types of policy and payment considerations that affect major vascular surgeries. The publication summarizes benchmarks where available, highlights relevant policy updates affecting surgical and inpatient vascular services, and clarifies common billing themes such as bundling, inpatient surgical DRG interactions, and documentation priorities. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35531CPTvascular-surgerymesenteric-bypassaorto-visceral-bypassinpatient-surgeryvein-graftsurgical-procedure

Billing Code Overview

CPT code 35531 describes a surgical bypass procedure in which the provider creates a bypass graft from the aorta to a portion of the celiac or mesenteric artery using a vein graft to bypass a vascular obstruction. This procedure is a major vascular surgery intended to restore blood flow to abdominal visceral circulation when native arterial flow is compromised.

Service type: Open vascular bypass grafting of visceral arteries
Typical site of service: Inpatient operating room (major tertiary or community hospital surgical setting)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with progressive postprandial abdominal pain, unintentional weight loss, and evidence of mesenteric ischemia on CT angiography is scheduled for open mesenteric bypass. The surgical team performs an aorto-mesenteric (aorto-celiac or aorto-mesenteric) bypass using an autologous vein graft to bypass an occlusive lesion of the celiac or superior mesenteric artery. Preoperative workflow includes vascular surgery consultation, arterial imaging (CTA or angiography), cardiac risk assessment, and informed consent for open revascularization. Intraoperative workflow includes general anesthesia, midline laparotomy or retroperitoneal exposure, harvest/preparation of the autologous vein graft, proximal aortic anastomosis, distal anastomosis to the mesenteric or celiac artery, hemostasis, and closure. Postoperative workflow includes intensive monitoring for graft patency, anticoagulation management, pain control, bowel function assessment, duplex surveillance or CTA prior to discharge, and coordination with nutrition and rehabilitation services for recovery and gradual advancement of diet.

Coding Specifications

Modifier	Description	When to Use
`00`	Default - No modifier selected	Rarely reported; indicates no modifier applies when required by payer systems
`11`

CPT 35512: Subclavian-to-Brachial Artery Vein Bypass

CPT-35508-CAROTID-TO-VERTEBRAL-BYPASS-GRAFT

CPT 35508: Carotid-to-Vertebral Artery Bypass Graft

CPT-35537-AORTO-ILIAC-BYPASS-VEIN-GRAFT

CPT 35537: Aorto‑iliac Bypass with Vein Graft

CPT-35523-BRACHIAL-TO-ULNAR-OR-RADIAL-VEIN-BYPASS

CPT 35523: Brachial to Ulnar or Radial Vein Bypass

CPT-35518-AXILLARY-ARTERY-TO-AXILLARY-ARTERY-BYPASS-VEIN-GRAFT

CPT 35518: Axillary-to-Axillary Artery Bypass with Vein Graft

CPT-35509-CAROTID-TO-CAROTID-VEIN-BYPASS-GRAFT

CPT 35509: Carotid-to-Carotid Bypass with Vein Graft

CPT-35536-SPLENIC-TO-RENAL-ARTERY-BYPASS-VEIN-GRAFT

CPT 35536: Splenic-to-Renal Artery Bypass with Vein Graft

CPT-35521-AXILLARY-TO-FEMORAL-VEIN-BYPASS

CPT 35521: Axillary-to-Femoral Vein Bypass

CPT-35506-CAROTID-TO-SUBCLAVIAN-BYPASS-GRAFT

CPT 35506: Carotid-to-Subclavian Bypass Graft

CPT-35511-SUBCLAVIAN-ARTERY-TO-SUBCLAVIAN-ARTERY-VEIN-BYPASS

CPT 35511: Subclavian-to-Subclavian Vein Bypass Graft

Showing 1–10 of 32

Taxonomy Code	Specialty	Notes
`207SX0100X`	Vascular Surgery	Primary specialty performing open aorto-mesenteric bypass procedures
`2080P0206X`	General Surgery	General surgeons with vascular expertise may perform this procedure in some centers
`2080S0121X`	Thoracic Surgery	Thoracic/vascular surgeons may participate when proximal aortic exposure or cardiothoracic input is required
`208100000X`	Interventional Radiology	Often involved preoperatively for diagnostic angiography and potential endovascular alternatives
`352600000X`	Anesthesiology	Provides intraoperative anesthesia care and perioperative risk management

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K55.0`	Acute vascular disorders of intestine	Represents acute mesenteric ischemia prompting emergent revascularization such as bypass
`K55.1`	Chronic vascular disorders of intestine	Chronic mesenteric ischemia is a common indication for mesenteric bypass when endovascular therapy is unsuitable
`I70.2`	Atherosclerosis of native arteries of the extremities (not otherwise specified)	Systemic atherosclerosis often coexists and indicates diffuse vascular disease contributing to mesenteric occlusive disease
`I80.9`	Phlebitis and thrombophlebitis of unspecified site	Relevant when vein graft harvest or thrombosis risk factors are present
`I82.9`	Embolism and thrombosis of unspecified vein	Thrombotic disease history may influence graft choice and anticoagulation

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35631`	Thromboendarterectomy, iliac artery, with patch	Performed for peripheral arterial disease in the same vascular patient; may be done prior to or concurrent with abdominal vascular reconstructions if multilevel disease exists
`36147`	Thrombectomy, dialysis graft, open; with replacement of graft	Different anatomic site but similar vascular graft techniques; relevant when discussing graft thrombosis management
`36120`	Transcatheter placement of vascular stent(s)	Endovascular alternative or adjunct for mesenteric revascularization; may be performed before considering open bypass
`36140`	Percutaneous transluminal mechanical thrombectomy	Endovascular procedure that can be used to restore mesenteric flow in select acute presentations
`76937`	Ultrasound guidance for vascular access	Used intraoperatively or preoperatively for vascular access or graft assessment

OpenPayer