How To Use CPT Code 33500

CPT 33500 describes the repair of a coronary arteriovenous or arteriocardiac chamber fistula, 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 33500?

CPT 33500 involves the repair of a coronary arteriovenous or arteriocardiac chamber fistula, with the assistance of cardiopulmonary bypass. This code is used when a healthcare provider closes off an abnormal passageway that allows blood to flow where it should not within the heart. The procedure is performed with the patient on cardiopulmonary bypass, and the provider may close the fistula from outside the heart or from inside a cardiac chamber.

2. Official Description

The official description of CPT code 33500 is: ‘Repair of coronary arteriovenous or arteriocardiac chamber fistula; with cardiopulmonary bypass.’

3. Procedure

1. The healthcare provider prepares and anesthetizes the patient.
2. The provider opens the chest, typically through a median sternotomy.
3. The pericardium is opened, and the coronary anatomy is inspected.
4. Cardiopulmonary bypass is established to temporarily take over the function of the heart and lungs.
5. The provider closes off the fistula, either from outside the heart or from inside the chamber in which it terminates.
6. If an incision is made into the heart, the provider repairs the incision in the chamber.
7. The patient is taken off cardiopulmonary bypass.
8. The provider removes any instruments, checks for bleeding, and closes the incision in the chest.

4. Qualifying circumstances

CPT 33500 is performed on patients with a coronary arteriovenous or arteriocardiac chamber fistula. This abnormal passageway connects a coronary artery to a heart chamber, either the atrium or the ventricle. The procedure requires the use of cardiopulmonary bypass, which temporarily takes over the function of the heart and lungs. The patient must be appropriately prepped and anesthetized, and the provider must perform the procedure with the necessary expertise and qualifications.

5. When to use CPT code 33500

CPT code 33500 should be used when a healthcare provider performs the repair of a coronary arteriovenous or arteriocardiac chamber fistula with the assistance of cardiopulmonary bypass. This code is not appropriate for repairs performed without the use of cardiopulmonary bypass or for repairs of other types of fistulas or anomalies.

6. Documentation requirements

To support a claim for CPT 33500, the healthcare provider must document the following information:

• Patient’s diagnosis and the presence of a coronary arteriovenous or arteriocardiac chamber fistula
• Details of the procedure, including the use of cardiopulmonary bypass
• Any specific techniques or approaches used during the repair
• Any complications or unexpected findings during the procedure
• Post-operative care instructions and any follow-up plans
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 33500, ensure that the procedure was performed with the use of cardiopulmonary bypass. It is important to distinguish this code from CPT 33501, which is used for repairs performed without cardiopulmonary bypass. Additionally, be aware of any specific billing guidelines or requirements from insurance providers or payers. It is also important to consider any applicable modifiers that may be required for accurate billing and reimbursement.

8. Historical information

CPT 33500 was added to the Current Procedural Terminology system on January 1, 1990. In 2017, it was added to the Inpatient Only (IPO) list for Medicare reimbursement.

9. Examples

1. A healthcare provider performs CPT 33500 to repair a coronary arteriovenous fistula connecting a coronary artery to the pulmonary venous circulation.
2. A patient with a coronary arteriocardiac chamber fistula undergoes CPT 33500 to close off the abnormal passageway between a coronary artery and the left atrium.
3. A healthcare provider performs CPT 33500 to repair a coronary arteriovenous fistula connecting a coronary artery to the right ventricle.
4. CPT 33500 is used to repair a coronary arteriocardiac chamber fistula between a coronary artery and the left ventricle.
5. A patient with a coronary arteriovenous fistula undergoes CPT 33500 to close off the abnormal passageway between a coronary artery and the right atrium.
6. A healthcare provider performs CPT 33500 to repair a coronary arteriocardiac chamber fistula between a coronary artery and the right ventricle.
7. CPT 33500 is used to repair a coronary arteriovenous fistula connecting a coronary artery to the left ventricle.
8. A patient with a coronary arteriocardiac chamber fistula undergoes CPT 33500 to close off the abnormal passageway between a coronary artery and the left atrium.
9. A healthcare provider performs CPT 33500 to repair a coronary arteriovenous fistula connecting a coronary artery to the right ventricle.
10. CPT 33500 is used to repair a coronary arteriocardiac chamber fistula between a coronary artery and the right atrium.