How To Use CPT Code 33840

CPT 33840 describes the excision of coarctation of the aorta, with or without associated patent ductus arteriosus, and the subsequent direct anastomosis. 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 33840?

CPT 33840 is used to describe the surgical procedure of excising a coarctation of the aorta, which is a narrowing of the main artery of the body. This procedure may also involve the repair of a patent ductus arteriosus, an abnormal communication between the pulmonary artery and the aorta. The excision is followed by a direct anastomosis, which involves connecting the two ends of the aorta together.

2. Official Description

The official description of CPT code 33840 is: ‘Excision of coarctation of aorta, with or without associated patent ductus arteriosus; with direct anastomosis.’

3. Procedure

1. The provider begins by accessing the coarctation of the aorta through a thoracotomy approach.
2. Vascular clamps are placed on the aorta to temporarily stop the blood flow.
3. If a patent ductus arteriosus is present, it is ligated or tied off, and the ductal and coarctation tissue is excised.
4. The provider then opens the aortic arch and connects it to the aorta, allowing for proper blood circulation throughout the body.
5. The incision is closed with sutures, and chest or drainage tubes may be placed before dressing the incision.

4. Qualifying circumstances

CPT 33840 is performed on patients with coarctation of the aorta, a narrowing of the main artery. The procedure may also involve the repair of a patent ductus arteriosus, an abnormal communication between the pulmonary artery and the aorta. The surgery is typically performed by a qualified healthcare professional with expertise in cardiovascular surgery.

5. When to use CPT code 33840

CPT code 33840 should be used when a provider performs the excision of a coarctation of the aorta, with or without associated patent ductus arteriosus, and subsequently performs a direct anastomosis. This code should not be used for procedures involving a graft instead of direct anastomosis or repair using the left subclavian artery or prosthetic material as a gusset for enlargement.

6. Documentation requirements

To support a claim for CPT 33840, the provider must document the following information:

• Patient’s diagnosis of coarctation of the aorta and any associated patent ductus arteriosus
• Description of the procedure performed, including the excision of the coarctation and any repair of the patent ductus arteriosus
• Date of the procedure
• Details of the surgical approach and technique used
• Any additional procedures performed during the same operative session
• Any complications or unexpected findings
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 33840, ensure that the excision of the coarctation of the aorta is performed with a direct anastomosis. It is important to follow the specific guidelines provided by the payer and to accurately report any additional procedures performed during the same operative session. It is also important to review any applicable bundling or unbundling rules to ensure proper reimbursement.

8. Historical information

CPT 33840 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 purposes.

9. Examples

1. A cardiovascular surgeon performs the excision of a coarctation of the aorta and subsequent direct anastomosis in a patient with a diagnosed narrowing of the main artery.
2. A pediatric cardiac surgeon performs the excision of a coarctation of the aorta and repair of a patent ductus arteriosus in an infant with congenital heart defects.
3. A cardiothoracic surgeon performs the excision of a coarctation of the aorta and direct anastomosis in an adult patient with a history of hypertension and cardiovascular disease.
4. A team of cardiovascular surgeons performs the excision of a coarctation of the aorta and subsequent direct anastomosis in a patient with a complex aortic anomaly.
5. A cardiac surgeon performs the excision of a coarctation of the aorta and repair of a patent ductus arteriosus in a teenager with a known congenital heart condition.
6. A cardiovascular surgeon performs the excision of a coarctation of the aorta and direct anastomosis in a patient with a history of multiple cardiac surgeries.
7. A pediatric cardiac surgeon performs the excision of a coarctation of the aorta and repair of a patent ductus arteriosus in an infant with critical congenital heart disease.
8. A cardiothoracic surgeon performs the excision of a coarctation of the aorta and subsequent direct anastomosis in a patient with a thoracic aortic aneurysm.
9. A team of cardiovascular surgeons performs the excision of a coarctation of the aorta and repair of a patent ductus arteriosus in a child with a complex cardiac anomaly.