How To Use CPT Code 33536

CPT 33536 describes the procedure of coronary artery bypass using four or more arterial grafts. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 33536?

CPT 33536 is used to describe the surgical procedure of coronary artery bypass using four or more arterial grafts. This code is used when the provider diverts blood flow from damaged vessels in the heart by grafting arterial segments from another location, such as the chest or abdomen, to restore circulation and improve heart function. The procedure aims to decrease symptoms like angina and improve the overall health of the patient.

2. Official Description

The official description of CPT code 33536 is: ‘Coronary artery bypass, using arterial graft(s); four or more coronary arterial grafts.’ This code specifically refers to the surgical procedure of bypassing damaged coronary arteries using arterial grafts.

3. Procedure

1. The provider begins by making a midline sternotomy incision through the breastbone to access the heart.
2. Aortic and venous cannulas are inserted to establish cardiopulmonary bypass, which temporarily takes over the function of the heart and lungs.
3. The provider injects a cardioplegia solution to stop the heart and create a motionless operative field.
4. Four or more arterial graft segments are harvested, typically from the left and right internal mammary arteries in the chest.
5. The arterial segments are grafted to appropriate locations on the sides of the diseased vessels, restoring blood flow to the heart.
6. If free grafts are used, the other ends are attached to holes punched in the aorta.
7. The patient is weaned off the bypass pump, and the provider ensures there is no bleeding and closes the incision in layers.

4. Qualifying circumstances

CPT 33536 is performed on patients who require coronary artery bypass surgery and have four or more coronary arterial grafts. This procedure is typically performed on patients with severe coronary artery disease or blockages in their heart vessels. The provider must assess the patient’s condition and determine the need for bypass surgery using arterial grafts.

5. When to use CPT code 33536

CPT code 33536 should be used when the provider performs a coronary artery bypass surgery using four or more arterial grafts. This code is appropriate when the procedure involves bypassing damaged coronary arteries to restore blood flow using arterial grafts. It should not be used for procedures involving fewer than four arterial grafts or when other types of grafts, such as venous grafts, are used.

6. Documentation requirements

To support a claim for CPT 33536, the provider must document the following information:

• Patient’s diagnosis and the need for coronary artery bypass surgery
• Number and type of arterial grafts used (four or more)
• Date of the procedure
• Details of the surgical technique and any additional procedures performed
• Any complications or unexpected findings during the surgery
• Post-operative care and follow-up plans
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 33536, ensure that the procedure involves the use of four or more arterial grafts. It is important to accurately document the number and type of grafts used in the procedure. CPT code 33536 should not be reported if fewer than four arterial grafts are used. It is also important to follow any specific billing guidelines provided by insurance companies or payers.

8. Historical information

CPT code 33536 was added to the Current Procedural Terminology system on January 1, 1993. The code underwent a change on January 1, 2010, with the description being updated to specify the use of four or more coronary arterial grafts. In 2017, it was added to the Inpatient Only (IPO) list for Medicare reimbursement.

9. Examples

1. A patient with severe coronary artery disease undergoes coronary artery bypass surgery using five arterial grafts to restore blood flow to the heart.
2. A provider performs coronary artery bypass surgery using six arterial grafts to bypass blocked coronary arteries in a patient with angina.
3. A patient with multiple blockages in their heart vessels undergoes coronary artery bypass surgery using seven arterial grafts to improve heart function.
4. A provider performs coronary artery bypass surgery using four arterial grafts and one venous graft to restore blood flow in a patient with significant coronary artery disease.
5. A patient with complex coronary artery disease undergoes coronary artery bypass surgery using eight arterial grafts to improve heart function and relieve symptoms of angina.
6. A provider performs coronary artery bypass surgery using four arterial grafts and two venous grafts to bypass blocked coronary arteries in a patient with multiple vessel disease.
7. A patient with severe blockages in their heart vessels undergoes coronary artery bypass surgery using five arterial grafts to restore blood flow and improve heart function.
8. A provider performs coronary artery bypass surgery using six arterial grafts to bypass blocked coronary arteries in a patient with significant coronary artery disease.
9. A patient with complex coronary artery disease undergoes coronary artery bypass surgery using four arterial grafts and one venous graft to improve heart function and relieve symptoms of angina.
10. A provider performs coronary artery bypass surgery using seven arterial grafts to restore blood flow in a patient with multiple vessel disease.