Open Abdominal Aortic Aneurysm Repair

CPT 35082
Approach Open
Add-on / Variant CPTs
  • 35092 — Repair aortic aneurysm, ruptured
Preoperative Diagnosis:

Abdominal aortic aneurysm — [X] cm maximum diameter / [ruptured / symptomatic / elective]

Postoperative Diagnosis:

Same

Procedure Performed:

Open abdominal aortic aneurysm repair with [tube graft / aorto-bi-iliac graft / aorto-bifemoral graft]

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Resident/PA name]

Anesthesia:

General endotracheal with epidural

Indications:

The patient is a [age]-year-old [male/female] with a [X]-cm abdominal aortic aneurysm presenting for elective [or urgent] open repair. Preoperative imaging demonstrated [aneurysm anatomy, extent, iliac involvement]. The risks, benefits, and alternatives including EVAR were discussed and informed consent was obtained.

Findings:

The aortic aneurysm measured [X] cm and extended from [just below the renal arteries / suprarenal] to [the aortic bifurcation / right and left common iliac arteries]. The aneurysm sac contained [laminated thrombus / calcification]. The infrarenal aortic neck was [adequate / short at X cm]. The iliac arteries were [normal / aneurysmal / occluded].

Description of Procedure:

The patient was positioned supine. A midline laparotomy was performed. The small bowel was packed to the right and the retroperitoneum was opened overlying the aorta. The infrarenal aortic neck was dissected and controlled below the left renal vein. The iliac arteries were dissected and controlled.

Systemic heparin [100 units/kg] was administered and ACT confirmed >250 seconds. The aorta was clamped infrarenally [or suprarenal clamp placed]. Iliac clamps were applied. The aneurysm sac was opened longitudinally and thrombus evacuated. Back-bleeding lumbar arteries were suture-ligated with [2-0 silk]. The inferior mesenteric artery was [reimplanted / ligated].

A [16 mm / 18 mm] [Dacron / PTFE] tube graft was sewn to the infrarenal aortic neck with running [3-0 Prolene]. The distal anastomosis was performed to the [aortic bifurcation / bilateral iliac arteries]. [For bifurcated graft: limbs sewn to each common iliac with running 3-0 Prolene.] Clamps were released sequentially and hemostasis confirmed. The aneurysm sac was closed over the graft.

Sigmoid colon viability was assessed — [doppler signal / capillary refill intact]. The abdomen was irrigated and closed in layers.

Complications:

None

Specimens:

Aortic thrombus and aneurysm wall sent to pathology

Estimated Blood Loss:

[X] mL; [X] units PRBC transfused; cell saver used

Drains:

None

Disposition:

The patient remained intubated and was transferred to the surgical ICU.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: AAA — *** cm, elective/ruptured
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Open AAA repair with ***
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: General ETT with epidural

INDICATIONS: .PTAGE-year-old .PTSEX with *** cm AAA. Neck *** cm. Iliacs: ***. Consent obtained.

FINDINGS: AAA *** cm, infrarenal/suprarenal. Neck ***. Iliacs ***. Thrombus: ***.

PROCEDURE:
Supine. Midline laparotomy. Retroperitoneum opened. Infrarenal aorta and iliac arteries controlled. Heparin *** units/kg, ACT >250. Infrarenal aortic clamp. Iliac clamps. Sac opened, thrombus evacuated. Lumbar arteries suture-ligated. IMA ***. *** graft sewn to infrarenal neck proximally, *** distally with 3-0 Prolene. Clamps released. Sac closed over graft. Sigmoid viability confirmed. Abdomen closed.

EBL: *** mL; *** units PRBC; cell saver
SPECIMENS: Aortic wall/thrombus to pathology
COMPLICATIONS: None
DISPOSITION: To SICU intubated.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Ruptured AAA

The patient presented in hemorrhagic shock with a ruptured AAA. On rapid entry, a large retroperitoneal hematoma was encountered. Immediate supraceliac aortic control was obtained at the aortic hiatus with digital compression until a clamp was placed. The remainder of the procedure followed the standard open repair technique. Massive transfusion protocol was activated. The abdomen was left open with damage control closure pending resuscitation.

Charting Tips
  • Document clamp time (aortic cross-clamp on/off times) in the operative note. This correlates with ischemic complications and is required for quality reporting and ACS NSQIP data submission.
  • Document sigmoid colon and lower extremity perfusion assessment after clamp release. IMA ligation and pelvic ischemia are well-recognized complications, and documenting a normal post-reperfusion assessment is critical.
  • Record heparin dose and ACT value confirming adequate anticoagulation before clamping. Document reversal with protamine at the end of the procedure.
Billing Tips
  • 35081 (open infrarenal AAA repair, elective, 32.69 wRVU) is the standard code for elective open aneurysm repair; 35082 (ruptured infrarenal, 41.04 wRVU) for emergent repair. Document elective vs ruptured.
  • Suprarenal/juxtarenal extension: 35091 (elective, 34.47 wRVU) or 35092 (ruptured, 49.70 wRVU). Use when suprarenal clamping or renal artery reconstruction is required.
  • Aortoiliac/aortobifemoral component: 35102 (35.62 wRVU) covers repair extending to iliac bifurcation, which is distinct from simple infrarenal repair. Document extent of aneurysm and graft configuration (tube vs bifurcated).
  • Endarterectomy of aorta performed concurrently is bundled. Do not separately bill 35331.
  • Renal artery reimplantation or bypass performed due to involvement is separately billable (35560, 35536) with modifier -51. Document each reconstructed vessel.
  • Global period is 90 days. Post-op complications including renal dysfunction, colonic ischemia evaluation, and wound management are bundled. Return to OR for hemorrhage or graft complications uses modifier -78.
  • Document aneurysm diameter (cm), extent (infrarenal vs juxtarenal vs suprarenal), clamp level, graft type and manufacturer, estimated blood loss, and renal ischemia time. All affect DRG, quality reporting, and coding defensibility.