How To Use CPT Code 33268

CPT 33268 describes the exclusion of the left atrial appendage (LAA) during a sternotomy or thoracotomy 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 33268?

CPT 33268 is used to describe the exclusion of the left atrial appendage (LAA) during a sternotomy or thoracotomy procedure. This code is used when the provider performs the exclusion of the LAA, such as by excision, at the same time as another open procedure. The LAA is a small, pouchlike sac located in the top left chamber of the heart. The exclusion of the LAA is performed to treat atrial fibrillation or reduce the likelihood of thromboembolic complications caused by blood clots.

2. Official Description

The official description of CPT code 33268 is: ‘Exclusion of left atrial appendage, open, performed at the time of other sternotomy or thoracotomy procedure(s), any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip) (List separately in addition to code for primary procedure).’ This code should be used in conjunction with the primary procedure performed via sternotomy or thoracotomy approach. It should not be reported with specific other codes listed in the notes.

3. Procedure

1. After the patient is appropriately prepped and anesthetized, the provider performs a sternotomy or thoracotomy procedure to access the heart.
2. The provider then performs the exclusion of the left atrial appendage (LAA) using any method deemed appropriate. This may include excision, isolation via stapling, oversewing, ligation, plication, or placing a clip.
3. Once the exclusion of the LAA is completed, the provider proceeds with the primary procedure.
4. After the primary procedure and LAA exclusion, the provider closes the surgical wounds.

4. Qualifying circumstances

CPT 33268 is performed when the exclusion of the left atrial appendage (LAA) is done at the same time as another sternotomy or thoracotomy procedure. The procedure is typically performed to treat atrial fibrillation or reduce the risk of thromboembolic complications. It is important to note that CPT 33268 should not be reported with specific other codes listed in the notes, such as 33254, 33255, 33256, and others.

5. When to use CPT code 33268

CPT code 33268 should be used when the exclusion of the left atrial appendage (LAA) is performed during a sternotomy or thoracotomy procedure. It is important to ensure that the procedure meets the qualifying circumstances and is not reported with the specific other codes listed in the notes.

6. Documentation requirements

To support a claim for CPT 33268, the provider must document the following information:

• Indication for the exclusion of the left atrial appendage (LAA)
• Details of the primary procedure performed via sternotomy or thoracotomy
• Method used for the exclusion of the LAA (eg, excision, stapling, oversewing)
• Date and duration of the procedure
• Any complications or additional findings during the procedure
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 33268, ensure that the exclusion of the left atrial appendage (LAA) is performed at the same time as another sternotomy or thoracotomy procedure. It is important to follow the guidelines and not report CPT 33268 with the specific other codes listed in the notes. Additionally, it is crucial to report CPT 33268 with an appropriate primary code to receive reimbursement.

8. Historical information

CPT 33268 was added to the Current Procedural Terminology system on January 1, 2022. As of its addition, there have been no updates or changes to the code. It is important to stay updated with any future changes or revisions to ensure accurate reporting.

9. Examples

1. A cardiothoracic surgeon performs a sternotomy procedure to access the heart and then performs the exclusion of the left atrial appendage (LAA) using excision during the same session.
2. During a thoracotomy procedure, a cardiac surgeon isolates the left atrial appendage (LAA) via stapling and performs the exclusion.
3. A patient with atrial fibrillation undergoes a sternotomy procedure, and the cardiothoracic surgeon performs the exclusion of the left atrial appendage (LAA) by oversewing it.
4. At the time of a thoracotomy procedure, a surgeon ligates the left atrial appendage (LAA) to exclude it and reduce the risk of thromboembolic complications.
5. During a sternotomy procedure, a cardiac surgeon performs the exclusion of the left atrial appendage (LAA) by placing a clip on it.
6. A patient with atrial fibrillation undergoes a thoracotomy procedure, and the surgeon performs the exclusion of the left atrial appendage (LAA) by plicating it.
7. At the time of a sternotomy procedure, a cardiothoracic surgeon performs the exclusion of the left atrial appendage (LAA) using excision and then proceeds with the primary procedure.