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Official Description

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, abdominal aorta

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 35081 refers to the surgical procedure for the direct repair of an abdominal aortic aneurysm or pseudoaneurysm, which may also involve excision (either partial or total) and the insertion of a graft, with or without the use of a patch graft. An abdominal aortic aneurysm is characterized by an abnormal enlargement or dilation of the abdominal aorta, which can lead to serious complications if not addressed. The causes of such aneurysms can include arteriosclerosis, mechanical obstructions like thoracic outlet syndrome, or malposition of the artery. Less frequently, conditions such as syphilis, tuberculosis, or abnormalities in the vessel wall, such as fibromuscular dysplasia, may also contribute to the formation of an aneurysm. In contrast, a pseudoaneurysm is a different entity; it does not involve all three layers of the arterial wall and is often 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 abdominal aorta itself is a critical vessel that extends from the thoracic aorta, traversing the abdominal cavity and bifurcating into the iliac arteries, which supply blood to the lower body. During the procedure, a midline abdominal incision is typically made to access the aorta, allowing for the careful dissection of surrounding tissues and the establishment of control over blood flow to facilitate the repair. The procedure is generally performed in a nonemergent, elective setting, distinguishing it from other codes that may pertain to emergency situations, such as the repair of a ruptured aneurysm.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 35081 is indicated for the surgical repair of the following conditions:

  • Abdominal Aortic Aneurysm - An abnormal enlargement or dilation of the abdominal aorta that poses a risk of rupture.
  • Pseudoaneurysm - A hematoma that forms in communication with the arterial wall, typically resulting from trauma or procedural complications.
  • Associated Occlusive Disease - Conditions that may accompany aneurysms, leading to compromised blood flow in the abdominal aorta.

2. Procedure

The procedure for CPT® Code 35081 involves several critical steps to ensure the successful repair of the aneurysm or pseudoaneurysm:

  • Step 1: Incision - A midline abdominal incision is made to provide access to the abdominal aorta. This incision may be transverse or retroperitoneal, depending on the surgeon's preference and the specific anatomy of the patient.
  • Step 2: Exposure - The overlying soft tissues are carefully divided to expose the abdominal aorta. The duodenum is dissected off the aorta to ensure clear visibility and access to the vessel.
  • Step 3: Control of Blood Flow - Proximal control is established below the renal arteries, and distal control is achieved above the iliac arteries. This step is crucial for managing blood flow during the repair process.
  • Step 4: Clamping - After diuresis and the administration of anticoagulants, the iliac arteries are clamped, along with the proximal aorta, to prevent blood loss during the procedure.
  • Step 5: Opening the Aneurysm Sac - The aneurysm sac is opened longitudinally, allowing for the removal of any aortic thrombus and plaque that may be present within the sac.
  • Step 6: Oversewing Arteries - The lumbar arteries and the inferior mesenteric artery are oversewn to prevent bleeding and ensure proper closure of the aorta.
  • Step 7: Graft Insertion - A synthetic tube graft or conduit is sutured to healthy aorta both distal and proximal to the site of the aneurysm, effectively replacing the damaged section of the artery.
  • Step 8: Closure of the Aneurysm Sac - After the graft is securely placed, the aneurysm sac is closed over the graft to restore the normal anatomy.
  • Step 9: Re-establishing Blood Flow - The clamps are released, and blood flow is re-established through the aorta and iliac arteries.
  • Step 10: Repair of the Retroperitoneum - The retroperitoneal space is repaired, and the abdomen is closed, completing the procedure.

3. Post-Procedure

Post-procedure care following the repair of an abdominal aortic aneurysm or pseudoaneurysm typically involves monitoring for complications such as bleeding, infection, or graft failure. Patients may require pain management and close observation in a recovery setting. Follow-up imaging may be necessary to assess the integrity of the graft and ensure that there are no complications. The recovery period can vary based on the patient's overall health and the complexity of the procedure, but patients are generally advised to avoid strenuous activities during the initial healing phase.

Short Descr REPAIR DEFECT OF ARTERY
Medium Descr DIR RPR ANEURYSM ABDOMINAL AORTA
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, abdominal aorta
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) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
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) P2B - Major procedure, cardiovascular-Aneurysm repair
MUE 1
CCS Clinical Classification 52 - Aortic resection, replacement or anastomosis
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).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
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.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
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.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, 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
CR Catastrophe/disaster related
GC This service has been performed in part by a resident under the direction of a teaching physician
KX Requirements specified in the medical policy have been met
LT Left side (used to identify procedures performed on the left side of the body)
X4 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
X5 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
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Action
Notes
2013-01-01 Changed Medium Descriptor changed.
2002-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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