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The CPT® Code 35021 refers to the surgical procedure involving the direct repair of an aneurysm or pseudoaneurysm, as well as the excision (either partial or total) and graft insertion, which may include the use of a patch graft. This procedure specifically targets the innominate or subclavian artery and is performed through a thoracic incision. An aneurysm is characterized by an abnormal enlargement or dilation of an artery, which can arise from various causes such as arteriosclerosis, mechanical obstructions like thoracic outlet syndrome, or malposition of the artery. Less frequently, aneurysms may be caused by infections such as syphilis or tuberculosis, or by structural abnormalities of the vessel wall, such as fibromuscular dysplasia. In contrast, a pseudoaneurysm is a condition that does not involve all three layers of the arterial wall and is typically the result of trauma—either blunt or penetrating—or complications from medical procedures, such as catheterization. This results in a pulsating hematoma that is encapsulated and communicates directly with the artery wall. The surgical approach for this procedure may involve harvesting a saphenous vein graft from the lower leg if necessary. The operation begins with a median sternotomy, which may be extended into the supraclavicular region or neck as required. During the procedure, the left brachiocephalic vein may be divided or mobilized to gain access to the innominate or subclavian artery, which is then clamped to facilitate the repair. The aneurysm sac is opened, and any thrombus or plaque is removed before the artery walls are sutured back together, with the potential application of an autogenous or synthetic patch graft. Alternative techniques may include end-to-end anastomosis of the vessel ends or the insertion of a tube graft, which is sutured to healthy artery segments. Once the repair is complete, clamps are released to restore blood flow. It is important to note that this procedure is classified as nonemergent and elective, distinguishing it from the emergency repair of a ruptured aneurysm, which is coded differently.
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The procedure described by CPT® Code 35021 is indicated for the surgical repair of the following conditions:
The procedure for CPT® Code 35021 involves several critical steps to ensure the successful repair of the aneurysm or pseudoaneurysm:
Post-procedure care following the repair of an aneurysm or pseudoaneurysm includes monitoring the patient for any signs of complications, such as bleeding or infection. Patients may require pain management and will be observed in a recovery area until they are stable. Follow-up imaging may be necessary to assess the success of the repair and ensure that there are no issues with blood flow. The patient will also receive instructions regarding activity restrictions and signs of potential complications to watch for during the recovery period.
| Short Descr | REPAIR DEFECT OF ARTERY | Medium Descr | DIR RPR ANEURYSM INNOMINATE/SUBCLAVIAN ARTERY | Long Descr | Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, innominate, subclavian artery, by thoracic incision | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 61 - Other OR procedures on vessels other than head and neck |
This is a primary code that can be used with these additional add-on codes.
| 35572 | Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Harvest of femoropopliteal vein, 1 segment, for vascular reconstruction procedure (eg, aortic, vena caval, coronary, peripheral artery) (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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