Summary & Overview
CPT 35820: Reopen Chest to Control Bleeding, Clotting, or Infection
CPT code 35820 denotes surgical reopening of the chest to identify and control postoperative bleeding, clotting, or infection after an earlier thoracic operation. Nationally, this code signals an emergent or urgent return-to-the-operating-room scenario with significant implications for patient safety, hospital resource use, and postoperative quality metrics. Payers commonly involved in coverage decisions for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise explanation of the clinical intent of CPT code 35820, typical settings where the service is furnished, and the payer landscape relevant to billing and coverage. The publication provides benchmarks and payment context, outlines common modifiers and billing considerations, and highlights clinical scenarios that commonly prompt use of the code. It also summarizes policy items and coding guidance that affect national reimbursement and reporting for re-entry thoracic procedures. This overview is aimed at coding professionals, hospital billing teams, and policy analysts seeking a clear, nationally-focused reference for CPT code 35820.
Billing Code Overview
CPT code 35820 describes a surgical re-entry into the chest to locate and correct ongoing bleeding, clotting, or infection following a prior thoracic operation. This procedure is a return to the operating room for postoperative complication management.
-
Service type: Surgical procedure for postoperative complication control
-
Typical site of service: Hospital operating room or other inpatient surgical setting
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old male who presents to the intensive care unit within 24–72 hours after a median sternotomy for coronary artery bypass grafting with increasing chest tube output, hypotension, and expanding mediastinal hematoma noted on chest radiograph. The surgical team returns the patient to the operating room for exploration of the chest. Intraoperative findings include active arterial bleeding from a graft anastomosis requiring hemostasis and evacuation of clot. The procedure involves reopening the prior chest incision (resternotomy), removal of clotted blood, identification and control of the bleeding source, revision of suture lines, and lavage of the mediastinum. Typical workflow steps: preoperative stabilization and consent, transport to OR, general anesthesia with endotracheal intubation, reopening of the prior incision, careful dissection to avoid injury to cardiac structures and grafts, evacuation of clots, direct control of bleeding (suture, topical hemostatic agents, cautery), irrigation and debridement if infection suspected, placement of drains, and closure or reapproximation of the chest as clinically indicated. Typical site of service is the hospital operating room; inpatient care in an ICU or step-down unit follows. Service type: an unplanned reoperation for control of hemorrhage, clot, or infection following a prior thoracic/cardiac procedure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural service | Use when the re-exploration requires substantially greater effort or time than usual due to extensive adhesions or complex repair beyond typical scope. |