CPT 35870 Graft‑Enteric Fistula Reimbursement | OpenPayer

Summary & Overview

CPT 35870: Repair of Vascular Graft‑to‑Intestine Fistula

CPT code 35870 denotes surgical repair of an abnormal opening between a vascular graft and the intestines (graft-enteric fistula). This is a high-acuity vascular surgery addressing life-threatening risks including hemorrhage, sepsis, and graft failure. Nationally, accurate use of this CPT code supports appropriate surgical care documentation, hospital resource allocation, and payer coverage determinations for complex inpatient procedures. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare.

Readers will find a concise clinical context for the procedure, common sites of service, and the typical service line implications for inpatient vascular surgery. The publication outlines payer coverage considerations and commonly reported modifiers (listed in the input) and identifies areas where coding clarity affects authorization and claim adjudication. Benchmarks and policy updates are summarized where available; when input data is missing for a particular element, the text indicates "Data not available in the input." The goal is to provide clinicians, billers, and policy analysts with a compact reference to support correct claim submission and administrative review for CPT code 35870.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicareCPT 35870vascular surgerygraft-enteric fistulasurgical repairinpatient surgeryprocedure codinghospital billingoperating room

Billing Code Overview

CPT code 35870 describes a surgical procedure in which the provider corrects an abnormal opening (fistula) between a vascular graft and the intestines. This procedure involves repair or closure of the graft-enteric communication to control infection risk, hemorrhage, and loss of graft function.

Service type: Surgical repair of graft-enteric fistula
Typical site of service: Operating room or other inpatient surgical setting

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a history of peripheral arterial disease and an aorto-bifemoral synthetic graft presents with fever, abdominal pain, and enteric drainage from a previous retroperitoneal incision. Imaging (CT abdomen/pelvis with contrast) demonstrates communication between the vascular graft and adjacent small bowel consistent with a graft-enteric fistula. The vascular surgery team evaluates the patient, confirms hemodynamic stability or addresses sepsis, and proceeds to the operating room for operative management. The procedure described by 35870 involves exploring the abdomen, identifying the abnormal opening between the vascular graft and the intestine, controlling contamination, and surgically closing or revising the fistulous communication. Intraoperative steps commonly include vascular control proximal and distal to the graft, bowel mobilization and possible segmental resection with primary anastomosis or diversion, graft debridement or partial graft revision, irrigation, and primary closure of the enteric defect. Postoperative management includes intensive monitoring for bleeding and infection, broad-spectrum antibiotics, and coordination with infectious disease for long-term graft infection management. Typical site of service is an inpatient operating room; this is a major surgical procedure performed by vascular surgeons often in conjunction with general or colorectal surgeons when bowel resection is required. Typical patient scenario: older adult with prior vascular graft placement presenting with signs of graft infection and enteric fistulization requiring urgent surgical repair under general anesthesia with possible bowel resection and graft management.

Coding Specifications

Modifier	Description	When to Use

CPT 35875: Removal of Clot from Non-Hemodialysis Vascular Graft

CPT-35876-CLOTTED-VASCULAR-GRAFT-REVISION-PATCHING

CPT 35876: Revision of Clotted Vascular Graft, Including Patching

CPT-35881-LOWER-EXTREMITY-BYPASS-GRAFT-VEIN-SEGMENT-REPLACEMENT

CPT 35881: Lower Extremity Bypass Graft Vein Segment Replacement

CPT-35840-ABDOMINAL-RE-EXPLORATION-FOR-BLEEDING-OR-INFECTION

CPT 35840: Abdominal Re-exploration for Bleeding or Infection

CPT-35907-EXCISION-INFECTED-ABDOMINAL-GRAFT

CPT 35907: Excision of Infected Abdominal Graft

CPT-35905-EXCISION-INFECTED-THORACIC-GRAFT

CPT 35905: Excision of Infected Thoracic Graft

CPT-35800-NECK-WOUND-EXPLORATION-CONTROL-BLEEDING-INFECTION

CPT 35800: Neck Exploration for Bleeding, Clot, or Infection

CPT-35700-ARTERIAL-BYPASS-GRAFT-REOPERATION

CPT 35700: Reoperation on Arterial Bypass Graft

CPT-35860-EXTREMITY-RE-EXPLORATION-FOR-BLEEDING-CLOTTING-INFECTION

CPT 35860: Re-exploration of Arm or Leg for Bleeding, Clotting, or Infection

CPT-35901-NECK-VASCULAR-GRAFT-REMOVAL-INFECTION

CPT 35901: Removal of Infected Neck Vascular Graft

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Taxonomy Code	Specialty	Notes
`208100000X`	Vascular Surgery	Primary specialty performing graft-related repairs and management of graft-enteric fistula
`208000000X`	General Surgery	Often assists or performs concurrent bowel resection and anastomosis
`208200000X`	Thoracic/Cardiovascular Surgery	Relevant when aortic grafts near thoracoabdominal junction are involved
`207K00000X`	Colorectal Surgery	Participates when complex bowel resection or pelvic dissection is required
`2084P0800X`	Interventional Radiology	May provide pre- or post-operative vascular imaging or percutaneous interventions

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K63.1`	Fistula of intestine	Directly describes an enteric fistula which can communicate with a vascular graft
`T82.7XXA`	Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter	Used when a vascular graft is infected, a common precursor to graft-enteric fistula
`I97.1`	Noninfective complication of vascular prosthetic device, implant and graft	Captures mechanical complications of vascular grafts that may relate to fistula formation
`K65.9`	Peritonitis, unspecified	Peritoneal contamination or infection from enteric leakage during graft-enteric fistula
`A41.9`	Sepsis, unspecified organism	Systemic infection that may occur secondary to graft infection and enteric contamination

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`34101`	Repair of arteriovenous malformation or excision of vascular lesion (Note: code example)	May be used when additional vascular repair or excision is required during graft-related surgery
`44120`	Enterectomy, resection of small intestine; single segment	Performed when segmental small bowel resection is required for infected or fistulized bowel adjacent to the graft
`44140`	Enterolysis (lysis of adhesions), small intestine	May be performed to mobilize bowel to access the graft-enteric fistula
`35866`	Reconstruction, iliac artery with graft; patch angioplasty or interposition graft (example)	May be used for graft revision or reconstruction when prosthetic graft segments are replaced or bypassed
`77012`	CT guidance for intraoperative localization (example)	Used for image guidance or intraoperative vascular imaging when needed

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