How To Use CPT Code 33257

CPT 33257 describes the operative tissue ablation and reconstruction of the atria, performed at the same time as another cardiac procedure. 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 33257?

CPT 33257 is used to describe the operative tissue ablation and reconstruction of the atria, which is performed during another cardiac procedure. This code is specifically used when the provider destroys abnormal tissue in the atria that is causing an abnormal heart rhythm, and then reconstructs the left and right atrium. The procedure is typically performed to treat atrial fibrillation, a condition characterized by rapid and irregular contractions of the atria due to abnormal electrical signals.

2. Official Description

The official description of CPT code 33257 is: ‘Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), limited (eg, modified maze procedure) (List separately in addition to code for primary procedure).’ This code should be used in conjunction with the primary procedure code for the other cardiac procedure(s) being performed.

3. Procedure

1. During the procedure, the patient is appropriately prepped and anesthetized.
2. The provider makes an incision in the chest wall to open the chest and expose the heart.
3. The pericardium, the double-layered membrane surrounding the heart, is then opened.
4. The provider isolates the pulmonary veins, which are the blood vessels that drain oxygenated blood into the left atrium.
5. Using energy sources such as a laser, heat, or cryotherapy, the provider creates multiple atrial lesions in the atria.
6. These lesions create scar tissue, which does not conduct electricity and helps block the abnormal electrical signals causing atrial fibrillation.
7. The provider then reconstructs the atria by suturing the incision line.
8. The pericardium is closed by suturing it, and any bleeding is stopped.
9. Finally, the layers of tissue in the chest wall are sutured together to close the incision.

4. Qualifying circumstances

CPT 33257 is performed when the provider needs to perform tissue ablation and reconstruction of the atria during another cardiac procedure. This procedure is typically limited in scope and may involve a modified maze procedure. It is important to note that CPT 33257 should be used in conjunction with the primary procedure code for the other cardiac procedure(s) being performed.

5. When to use CPT code 33257

CPT code 33257 should be used when the provider performs operative tissue ablation and reconstruction of the atria at the same time as another cardiac procedure. It is important to ensure that the primary procedure code for the other cardiac procedure(s) being performed is also reported in addition to CPT 33257.

6. Documentation requirements

To support a claim for CPT 33257, the provider must document the following information:

• Indication for the procedure and the need for tissue ablation and reconstruction of the atria
• Details of the primary procedure(s) being performed
• Description of the specific technique used for tissue ablation and reconstruction
• Date of the procedure
• Start and end times of the procedure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 33257, it is important to ensure that the procedure meets the qualifying circumstances and is performed at the same time as another cardiac procedure. This code should be reported in addition to the primary procedure code(s) for the other cardiac procedure(s) being performed. It is also important to note that CPT 33257 is an add-on code and should not be reported without an appropriate primary code. Additionally, there are other specific codes available for extensive tissue ablation and reconstruction of the atria performed with or without cardiopulmonary bypass.

8. Historical information

CPT 33257 was added to the Current Procedural Terminology system on January 1, 2008. There have been no updates to the code since its addition. It is worth noting that this procedure was added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A patient undergoes a coronary artery bypass grafting procedure, and during the same surgery, the provider performs tissue ablation and reconstruction of the atria to treat atrial fibrillation.
2. During a mitral valve repair procedure, the provider also performs tissue ablation and reconstruction of the atria to address atrial fibrillation.
3. A patient undergoes a pacemaker implantation procedure, and the provider performs tissue ablation and reconstruction of the atria to manage atrial fibrillation.
4. During a heart valve replacement procedure, the provider also performs tissue ablation and reconstruction of the atria to treat atrial fibrillation.
5. A patient undergoes a cardiac ablation procedure, and the provider performs tissue ablation and reconstruction of the atria to address atrial fibrillation.
6. During a coronary artery bypass grafting procedure, the provider also performs tissue ablation and reconstruction of the atria to manage atrial fibrillation.
7. A patient undergoes a heart transplant procedure, and the provider performs tissue ablation and reconstruction of the atria to treat atrial fibrillation.