Summary & Overview
CPT 35905: Excision of Infected Thoracic Graft
CPT code 35905 denotes the surgical excision of a previously placed thoracic graft that has become infected. This technically complex procedure is clinically significant because infected grafts in the chest can lead to systemic infection, mediastinitis, or vascular compromise, and removal is often required to control infection and preserve patient safety. Nationally, appropriate coding and coverage for this code affect hospital billing, resource allocation, and surgical quality measurement.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of typical sites of service and clinical context for the procedure, benchmarks where available, and discussion of relevant policy considerations that influence coverage and billing. The publication also summarizes common modifier usage when available and highlights issues related to coding specificity for thoracic graft removal.
This report is intended for clinicians, coding professionals, and policy analysts who need a concise reference on clinical definition, payer considerations, and the policy context surrounding CPT code 35905. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 35905 describes the surgical excision of a previously placed thoracic (chest) graft that has become infected. This procedure involves removal of the infected graft material from the chest wall or thoracic vasculature and may include debridement of surrounding infected tissue.
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Service type: Surgical excision of infected graft
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Typical site of service: Inpatient or outpatient operating room or surgical suite in a hospital setting
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old male with a synthetic or biologic thoracic (chest) graft placed previously for vascular reconstruction or thoracic wall reconstruction who presents with signs of graft infection such as fever, erythema, wound drainage, localized pain, or systemic sepsis. Initial evaluation includes physical exam, blood cultures, wound cultures, and cross-sectional imaging (CT chest with contrast) to assess graft integrity and surrounding fluid or abscess. The clinical workflow leading to the procedure 35905 generally involves: preoperative optimization (antibiotics directed by culture, hemodynamic stabilization), multidisciplinary review (vascular surgery, cardiothoracic surgery, infectious disease), informed consent, and operative planning for explantation of the infected graft. Intraoperative steps include exposure of the chest graft, control of vascular inflow/outflow as needed, careful excision of the infected prosthesis and devitalized tissue, debridement, thorough irrigation, possible temporary or definitive reconstruction (revascularization with autologous conduit or extra-anatomic bypass if indicated), and wound management (primary closure, delayed closure, or negative-pressure wound therapy). Postoperative care includes continuation of targeted IV antibiotics, wound surveillance, and monitoring for recurrent infection or graft-related complications. Typical site of service is an inpatient operating room within a hospital, often performed under general anesthesia. Service type: major surgical procedure — explantation of an infected thoracic graft.
Coding Specifications
| Modifier | Description | When to Use |
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