How To Use CPT Code 33504

CPT 33504 describes the repair of an anomalous coronary artery from the pulmonary artery origin using a graft, with the assistance 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 33504?

CPT 33504 can be used to describe the surgical repair of an anomalous coronary artery that arises irregularly from the pulmonary artery. This procedure involves using a graft to improve circulation to the heart and treat congestive heart failure caused by the defect. The repair is performed with the patient on cardiopulmonary bypass, and it aims to establish a bypass graft from the aorta to the coronary artery.

2. Official Description

The official description of CPT code 33504 is: ‘Repair of anomalous coronary artery from pulmonary artery origin; by graft, with cardiopulmonary bypass.’

3. Procedure

1. The provider prepares the patient for surgery and administers anesthesia.
2. An incision is made in the chest, typically a median sternotomy, to access the heart.
3. The provider initiates cardiopulmonary bypass (CPB) to temporarily take over the function of the heart and lungs.
4. The anomalous coronary artery near its pulmonary artery origin is ligated.
5. A graft, such as a healthy vessel taken from another area, is used to create a bypass from the aorta to the coronary artery.
6. The provider sutures the graft to the aorta and the coronary artery, creating a side-to-side anastomosis.
7. The bypass graft restores circulation to the affected area of the heart.
8. The patient is taken off CPB, and the provider ensures there is no bleeding.
9. The chest incision is closed, and the surgery is completed.

4. Qualifying circumstances

CPT 33504 is performed on patients with an anomalous coronary artery arising from the pulmonary artery. This congenital heart defect, also known as Bland White Garland syndrome, typically affects the left coronary artery, although an anomalous right coronary artery is less common. The procedure is indicated when the patient experiences congestive heart failure due to the defect, and the repair aims to improve circulation to the heart.

5. When to use CPT code 33504

CPT code 33504 should be used when a provider performs the repair of an anomalous coronary artery from the pulmonary artery origin using a graft, with the assistance of cardiopulmonary bypass. This code is appropriate for cases where the patient’s condition requires surgical intervention to improve circulation to the heart and treat congestive heart failure caused by the defect.

6. Documentation requirements

To support a claim for CPT 33504, the provider must document the following information:

• Patient’s diagnosis of an anomalous coronary artery arising from the pulmonary artery
• Description of the surgical procedure performed, including the use of a graft and cardiopulmonary bypass
• Date of the surgery
• Details of the graft used, such as the source and type
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 33504, ensure that the procedure involves the repair of an anomalous coronary artery from the pulmonary artery origin using a graft, with the assistance of cardiopulmonary bypass. It is important to follow the appropriate coding guidelines and documentation requirements. Additionally, consider any specific billing guidelines provided by insurance carriers or payers.

8. Historical information

CPT 33504 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2006, with the addition of the phrase ‘by graft.’ In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A 45-year-old patient undergoes surgery for the repair of an anomalous left coronary artery arising from the pulmonary artery. The provider performs the procedure using a graft and cardiopulmonary bypass to establish a bypass from the aorta to the coronary artery.
2. A 30-year-old patient with congestive heart failure due to an anomalous right coronary artery arising from the pulmonary artery undergoes surgery. The provider performs the repair using a graft and cardiopulmonary bypass to improve circulation to the heart.
3. A 50-year-old patient presents with symptoms of chest pain and shortness of breath. Diagnostic tests reveal an anomalous left coronary artery arising from the pulmonary artery. The provider recommends surgery to repair the defect and restore proper blood flow to the heart.
4. A 65-year-old patient with a history of congestive heart failure undergoes surgery for the repair of an anomalous coronary artery arising from the pulmonary artery. The provider performs the procedure using a graft and cardiopulmonary bypass to alleviate symptoms and improve cardiac function.
5. A 55-year-old patient is diagnosed with an anomalous right coronary artery arising from the pulmonary artery. The provider recommends surgical repair to prevent further complications and improve the patient’s overall cardiovascular health.
6. A 40-year-old patient with a known anomalous left coronary artery arising from the pulmonary artery undergoes surgery. The provider performs the repair using a graft and cardiopulmonary bypass to restore proper blood flow and reduce the risk of congestive heart failure.
7. A 70-year-old patient presents with symptoms of angina and is diagnosed with an anomalous right coronary artery arising from the pulmonary artery. The provider recommends surgical intervention to improve blood flow to the heart and alleviate symptoms.