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Official Description

Excision of infected graft; thorax

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 35905 involves the excision of an infected vascular graft located in the thorax. This surgical intervention is necessary when a vascular graft, which is a synthetic or biological conduit used to restore blood flow, becomes infected. The presence of infection can compromise the integrity of the graft and the surrounding tissues, leading to potential complications if not addressed promptly. During the procedure, the surgeon must ensure that adequate blood flow to the affected organ or limb is maintained, which typically necessitates a separate re-vascularization procedure involving the placement of a new graft prior to the removal of the infected one. This careful approach is crucial to prevent ischemia, which is a condition characterized by insufficient blood supply to tissues. The surgical steps include exposing the infected graft, clamping the inflow and outflow arteries, excising the graft, debriding the arterial walls at the anastomosis sites, and repairing any defects in the arterial walls with sutures. This comprehensive process aims to eliminate the infection while preserving the vascular integrity of the thoracic region.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The excision of an infected graft in the thorax, as described by CPT® Code 35905, is indicated in the following situations:

  • Infected Vascular Graft The primary indication for this procedure is the presence of an infection in a vascular graft located in the thoracic region, which may lead to complications if not surgically addressed.
  • Compromised Blood Flow The procedure is also indicated when the infected graft threatens to compromise blood flow to the associated organ or limb, necessitating intervention to restore adequate perfusion.

2. Procedure

The procedure for excising an infected graft in the thorax involves several critical steps:

  • Step 1: Preparation for Surgery Prior to the excision, a separate re-vascularization procedure is typically performed to place a new graft. This step is essential to ensure that the affected organ or limb continues to receive adequate blood supply during and after the excision of the infected graft.
  • Step 2: Exposure of the Infected Graft The surgeon then exposes the infected graft by carefully dissecting it free from the surrounding tissues. This step is crucial to access the graft without causing additional damage to adjacent structures.
  • Step 3: Clamping of Arteries Once the graft is exposed, the inflow and outflow arteries are clamped above and below the graft. This clamping is necessary to control blood flow and minimize bleeding during the excision process.
  • Step 4: Excision of the Graft The infected graft is then excised from the thoracic region. This involves cutting through the tissue to remove the graft completely, ensuring that all infected material is eliminated.
  • Step 5: Debridement of Arterial Walls After the graft is removed, the inflow and outflow arterial walls at the proximal and distal anastomosis sites are debrided. This debridement continues until normal, non-inflamed arterial tissue is encountered, which is vital for proper healing and function.
  • Step 6: Debridement of Inflamed Tissue Any inflamed tissue surrounding the graft site is also debrided to further reduce the risk of infection and promote healing.
  • Step 7: Repair of Arterial Defect Finally, the arterial defect created by the excision of the graft is repaired using sutures. This step is essential to restore the integrity of the vascular system and ensure proper blood flow post-procedure.

3. Post-Procedure

Post-procedure care following the excision of an infected graft in the thorax includes monitoring for signs of infection, ensuring proper healing of the surgical site, and assessing the functionality of the newly placed graft. Patients may require follow-up imaging studies to evaluate blood flow and the condition of the surrounding tissues. Additionally, pain management and wound care instructions will be provided to facilitate recovery. It is important for healthcare providers to monitor the patient closely for any complications that may arise during the recovery period.

Short Descr EXCISION GRAFT THORAX
Medium Descr EXCISION INFECTED GRAFT THORAX
Long Descr Excision of infected graft; thorax
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) 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)
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.
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.)
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
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)
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2011-01-01 Changed Short description changed.
1994-01-01 Added First appearance in code book in 1994.
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