Summary & Overview
CPT 35903: Excision of Infected Arm or Leg Graft
CPT code 35903 represents surgical excision of a previously placed arm or leg graft that has become infected. This procedure is clinically significant because removal of infected vascular grafts is often required to control sepsis, preserve limb viability, and prevent systemic complications. Nationally, coding and reimbursement for infected graft excision affect hospitals, vascular surgery practices, and payer case management given the procedure’s implications for length of stay and downstream care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for CPT code 35903, typical sites of service, common payer considerations, and where to look for billing and policy guidance. The publication summarizes available benchmarks where present and notes policy issues relevant to surgical excision of infected extremity grafts.
This summary is intended for billing managers, vascular surgeons, hospital coders, and policy analysts seeking a national-level briefing on the code’s clinical meaning, payer landscape, and areas where coding and authorization practices commonly arise. Data not available in the input is noted where relevant.
Billing Code Overview
CPT code 35903 describes the excision of a previously placed arterial or venous graft in the arm or leg that has become infected. This procedure involves surgical removal of an infected extremity graft to control infection and prevent further complications.
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Service type: Surgical excision of an infected extremity graft
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Typical site of service: Operating room or surgical suite, often performed in an inpatient or outpatient hospital setting depending on patient condition
Clinical & Coding Specifications
Clinical Context
A typical patient is a middle-aged adult with a previously placed autogenous or prosthetic vascular graft in the upper or lower extremity who presents with signs of graft infection such as localized erythema, drainage, swelling, pain, systemic fever, or bacteremia. Preoperative evaluation includes history and physical, vascular imaging (duplex ultrasound, CT angiography) to assess graft integrity and distal perfusion, and laboratory studies including blood cultures and inflammatory markers. The surgical team performs explantation of the infected graft in an operating room under general or regional anesthesia. Intraoperative steps include proximal and distal vascular control, removal of the graft material, thorough debridement of infected tissue, irrigation, culture of graft and tissue, and assessment of limb perfusion. Depending on the clinical scenario, immediate or staged revascularization (eg, bypass using autologous conduit or prosthetic graft) may follow, or the limb may be managed with antibiotic therapy and delayed reconstruction. Typical sites of service are the hospital operating room or an ambulatory surgical center when clinically appropriate. Perioperative documentation should include the original graft type and location, indications for removal, operative findings, cultures obtained, hemostasis method, complications, estimated blood loss, and postoperative plan including antibiotics and follow-up vascular surgery or wound care visits.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normally distinct procedural service |