How To Use CPT Code 33256

CPT 33256 describes the operative tissue ablation and reconstruction of the atria, specifically an extensive procedure known as the maze procedure, with the use of cardiopulmonary bypass. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 33256?

CPT 33256 is used to describe a surgical procedure in which the provider destroys extensive tissue of the atria of the heart causing an abnormal heart rhythm and then reconstructs the left and right atrium. This procedure, known as the maze procedure, is performed to treat atrial fibrillation, a condition in which abnormal electrical signals cause the atria to contract rapidly and irregularly. The provider places the patient on cardiopulmonary bypass during this extensive ablation and reconstruction of the atria.

2. Official Description

The official description of CPT code 33256 is: ‘Operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure); with cardiopulmonary bypass.’ It is important to note that this procedure should not be reported in conjunction with certain other codes, as specified in the notes.

3. Procedure

1. The provider begins by making an incision in the chest wall to open the chest and expose the heart.
2. If necessary, the provider places the patient on cardiopulmonary bypass, a technique that temporarily takes over the function of the heart and lungs to maintain blood circulation and oxygenation.
3. The provider then opens the pericardium, the membrane surrounding the heart, and isolates the pulmonary veins.
4. Multiple atrial lesions are created by making small incisions on the atrial surface, both in the atria and the atrial septum.
5. These lesions create scar tissue, which blocks the abnormal electrical signals causing atrial fibrillation.
6. The provider reconstructs the atria by suturing the incision line and closes the pericardium.
7. Any bleeding is stopped, and the patient is weaned off cardiopulmonary bypass.
8. The incisions made for the bypass are closed, leaving areas for blood and fluid drainage.
9. Finally, the provider sutures the layers of tissue together to close the chest wall.

4. Qualifying circumstances

CPT 33256 is performed on patients with atrial fibrillation, a condition characterized by abnormal electrical signals in the atria. The procedure is extensive and involves the destruction of extensive tissue in the atria, followed by reconstruction. The use of cardiopulmonary bypass is a qualifying circumstance for this code.

5. When to use CPT code 33256

CPT code 33256 should be used when the provider performs an extensive tissue ablation and reconstruction of the atria, specifically the maze procedure, with the use of cardiopulmonary bypass. It is important to note that this code should not be reported in conjunction with certain other codes, as specified in the notes.

6. Documentation requirements

To support a claim for CPT 33256, the provider must document the following information:

• Patient’s diagnosis of atrial fibrillation
• Details of the extensive tissue ablation and reconstruction procedure
• Use of cardiopulmonary bypass during the procedure
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 33256, ensure that the procedure meets the criteria for an extensive tissue ablation and reconstruction of the atria with the use of cardiopulmonary bypass. It is important to review the notes and avoid reporting this code in conjunction with certain other codes. Additionally, consider using the appropriate modifiers if necessary.

8. Historical information

CPT 33256 was added to the Current Procedural Terminology system on January 1, 2007. It was later added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A patient with atrial fibrillation undergoes an extensive tissue ablation and reconstruction of the atria, known as the maze procedure, with the use of cardiopulmonary bypass.
2. A provider performs an extensive ablation and reconstruction of the atria using the maze procedure on a patient with persistent atrial fibrillation.
3. During a surgical procedure, the provider destroys extensive tissue in the atria and reconstructs the left and right atrium to treat atrial fibrillation.
4. A patient with atrial fibrillation undergoes an extensive tissue ablation and reconstruction of the atria, specifically the maze procedure, with the assistance of cardiopulmonary bypass.
5. A provider performs an extensive ablation and reconstruction of the atria using the maze procedure on a patient with recurrent atrial fibrillation.
6. During a surgical procedure, the provider destroys extensive tissue in the atria and reconstructs the left and right atrium to restore normal heart rhythm in a patient with atrial fibrillation.
7. A patient with atrial fibrillation undergoes an extensive tissue ablation and reconstruction of the atria, known as the maze procedure, with the use of cardiopulmonary bypass to correct the abnormal heart rhythm.
8. A provider performs an extensive ablation and reconstruction of the atria using the maze procedure on a patient with symptomatic atrial fibrillation.