© Copyright 2025 American Medical Association. All rights reserved.
The procedure described by CPT® Code 35091 involves the surgical intervention for an abdominal aortic aneurysm or pseudoaneurysm that also affects the visceral vessels, specifically the mesenteric, celiac, and renal arteries. 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 may include arteriosclerosis, mechanical obstructions, or less common factors such as infections or vessel wall abnormalities. A pseudoaneurysm, on the other hand, is a hematoma that forms in communication with the artery wall but does not involve all three layers of the arterial wall, often resulting from trauma or procedural complications. The surgical approach for this procedure may involve direct repair or excision of the aneurysm, along with the insertion of a graft, which may be accompanied by a patch graft if necessary. This intervention is critical for restoring normal blood flow and preventing potential rupture, which can lead to life-threatening situations. The procedure is performed in a controlled, elective setting, ensuring that all necessary precautions and preparations are in place to manage the patient's condition effectively.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 35091 is indicated for the following conditions:
The surgical procedure for CPT® Code 35091 involves several critical steps to ensure effective repair of the aneurysm or pseudoaneurysm. The first step is the preparation of the patient, which may include harvesting a saphenous vein graft if required for the repair of the visceral vessel. A surgical incision is then made, which can be a midline abdominal, transverse, or retroperitoneal flank incision, to access the abdominal aorta and the involved visceral vessels. Once the incision is made, the overlying soft tissues are carefully divided to expose the aorta. The duodenum is dissected away from the aorta to provide clear access to the vessel. Next, proximal control is established above the celiac arteries and distal control is secured above the iliac arteries. This is crucial for managing blood flow during the procedure. To achieve supraceliac aortic control, ligaments to the left lateral segment of the liver are divided, and the liver is retracted. The fibromuscular bands of the diaphragm are separated to further mobilize the aorta. After ensuring adequate exposure, diuresis and anticoagulation are administered, and the iliac arteries are clamped, along with the proximal aorta. The aneurysm sac is then opened longitudinally, and any thrombus present within the aorta is removed. The lumbar arteries and the inferior mesenteric artery are oversewn to prevent bleeding. A synthetic tube graft is then sutured to the healthy aorta both distal and proximal to the aneurysm site. If necessary, the visceral artery is repaired using either an autogenous saphenous vein graft or a synthetic patch or tube graft. After the graft is placed, the aneurysm sac is closed over the graft, clamps are released, and normal blood flow is re-established. Finally, the retroperitoneum is repaired, and the abdominal incision is closed to complete the procedure.
Post-procedure care following the surgical repair of an abdominal aortic aneurysm or pseudoaneurysm involves monitoring the patient for any signs of complications, such as bleeding or infection. Patients are typically observed in a recovery area before being transferred to a hospital room for further monitoring. Pain management is provided as needed, and the surgical site is assessed for proper healing. Follow-up imaging may be required to ensure the integrity of the graft and to monitor for any potential complications. Patients are usually advised on activity restrictions and follow-up appointments to ensure a successful recovery and to address any concerns that may arise during the healing process.
| Short Descr | REPAIR DEFECT OF ARTERY | Medium Descr | DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS | 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 involving visceral vessels (mesenteric, celiac, renal) | 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) | 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. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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. | 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 | 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) | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
Get instant expert-level medical coding assistance.