How To Use CPT Code 33866

CPT 33866 describes the placement of a graft in a specific part of the aortic arch, extending under one or more of the vessels that branch off from the arch. 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 33866?

CPT 33866 can be used to describe the placement of a graft in a specific area of the aortic arch, extending under one or more of the vessels that branch off from the arch. This code is used when the provider performs this procedure in conjunction with an ascending aortic graft. It is important to note that CPT 33866 should not be reported in conjunction with CPT 33871.

2. Official Description

The official description of CPT code 33866 is: ‘Aortic hemiarch graft including isolation and control of the arch vessels, beveled open distal aortic anastomosis extending under one or more of the arch vessels, and total circulatory arrest or isolated cerebral perfusion (List separately in addition to code for primary procedure).’ It is important to note that this code should be used when the procedure is performed in conjunction with an ascending aortic graft.

3. Procedure

1. The provider begins by assessing the patient’s condition and determining the need for aortic hemiarch graft placement.
2. After exposing the heart and great vessels through a median sternotomy incision, the provider cannulates the aorta and the superior and inferior venae cavae.
3. The provider then proceeds to isolate and control the arch vessels, placing clamps on the three brachiocephalic branches that take off from the arch.
4. Next, the provider transects the aortic arch obliquely and removes part of the lesser curvature of the arch.
5. A graft with a beveled end is prepared and sewn to the distal aspect of the lesser curvature of the arch in a curvilinear fashion, sparing the ostia of the brachiocephalic vessels.
6. The provider cannulates the side arm of the graft, de-airs the arch and graft, and resumes pump flow.
7. The proximal anastomosis is completed while rewarming the patient.
8. Finally, the provider continues with the primary vascular procedure.

4. Qualifying circumstances

CPT 33866 is performed on patients who require aortic hemiarch graft placement in conjunction with an ascending aortic graft. The procedure involves isolating and controlling the arch vessels, beveled open distal aortic anastomosis extending under one or more of the arch vessels, and total circulatory arrest or isolated cerebral perfusion. It is important to note that CPT 33866 should not be reported in conjunction with CPT 33871.

5. When to use CPT code 33866

CPT code 33866 should be used when the provider performs aortic hemiarch graft placement in conjunction with an ascending aortic graft. It is important to note that this code should not be reported in conjunction with CPT 33871.

6. Documentation requirements

To support a claim for CPT 33866, the provider must document the following information:

• Patient’s diagnosis and the need for aortic hemiarch graft placement
• Details of the procedure, including the isolation and control of the arch vessels, beveled open distal aortic anastomosis, and any additional procedures performed
• Date of the procedure
• Start and end time of the procedure
• Any complications or unexpected findings
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 33866, ensure that the procedure is performed in conjunction with an ascending aortic graft. Do not report CPT 33866 in conjunction with CPT 33871. It is important to follow the specific guidelines provided by the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT 33866 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A patient with a thoracic aortic aneurysm undergoes a primary vascular procedure, and the provider performs aortic hemiarch graft placement in conjunction with an ascending aortic graft.
2. During a surgical intervention for aortic dissection, the provider determines that aortic hemiarch graft placement is necessary and performs the procedure in conjunction with an ascending aortic graft.
3. A patient with a complex aortic pathology requires aortic hemiarch graft placement in conjunction with an ascending aortic graft to address the condition.
4. As part of a planned surgical intervention for aortic valve replacement, the provider performs aortic hemiarch graft placement in conjunction with an ascending aortic graft.
5. A patient with a thoracic aortic aneurysm and significant arch involvement undergoes a primary vascular procedure, and the provider performs aortic hemiarch graft placement in conjunction with an ascending aortic graft.
6. During a surgical intervention for aortic coarctation, the provider determines that aortic hemiarch graft placement is necessary and performs the procedure in conjunction with an ascending aortic graft.