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Official Description

Suture repair of aorta or great vessels; with shunt bypass

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 33321 involves the suture repair of the aorta or great vessels, specifically when a shunt bypass is utilized. This surgical intervention is critical in addressing injuries to the aorta or great vessels, which can arise from various forms of trauma, including both blunt and penetrating injuries. Such injuries may lead to severe complications such as transection, rupture, tear, or laceration of the aorta or great vessels, necessitating immediate surgical repair to restore vascular integrity and prevent life-threatening hemorrhage. The use of a shunt bypass during the repair process allows for the maintenance of distal aortic perfusion, which is essential for ensuring adequate blood flow to the body's organs and tissues while the repair is being performed. This procedure is typically conducted through a thoracotomy, where the surgeon gains access to the thoracic cavity to directly visualize and repair the damaged vessels. The complexity of this procedure underscores the importance of precise surgical techniques and careful management of the surrounding anatomical structures to achieve a successful outcome.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The suture repair of the aorta or great vessels with shunt bypass is indicated in the following scenarios:

  • Traumatic Injury Injuries to the aorta or great vessels resulting from blunt or penetrating trauma.
  • Aortic Transection Complete or partial transection of the aorta necessitating surgical intervention.
  • Aortic Rupture Rupture of the aorta or great vessels leading to significant hemorrhage.
  • Aortic Tear or Laceration Lacerations or tears in the aorta or great vessels that require surgical repair to restore vascular integrity.

2. Procedure

The procedure for suture repair of the aorta or great vessels with shunt bypass involves several critical steps:

  • Step 1: Thoracotomy A thoracotomy is performed to access the thoracic cavity, allowing the surgeon to visualize the aorta and great vessels directly. This incision provides the necessary exposure to the injured area.
  • Step 2: Exposure of Injured Vessels The pleura is incised, and the left superior pulmonary vein is isolated. The phrenic nerves are identified, mobilized, and protected to prevent damage during the procedure.
  • Step 3: Identification of Surrounding Structures The anterior surface of the aorta is exposed, and the innominate, left common carotid, and left subclavian arteries are identified to ensure proper navigation around these critical vessels.
  • Step 4: Control of Bleeding Umbilical tape is placed around the area proximal and distal to the injury to control bleeding in the event of hemorrhage during the repair process.
  • Step 5: Dissection Tissue adherent to the inferior surface of the aorta is divided, and the aortic arch is separated from the pulmonary artery, left common carotid, and left subclavian arteries using both blunt and sharp dissection techniques.
  • Step 6: Initiation of Bypass At this stage, the aorta may be cross-clamped, or shunt bypass or cardiopulmonary bypass may be initiated to maintain distal perfusion while the repair is performed.
  • Step 7: Full Exposure of the Aorta The mediastinal pleura is opened, allowing for full exposure of the aorta, which is essential for accessing the site of injury.
  • Step 8: Suture Repair The aortic injury is then meticulously repaired using sutures, ensuring that the integrity of the vessel is restored.
  • Step 9: Termination of Bypass Following the suture repair, shunt or cardiopulmonary bypass is terminated if it was utilized during the procedure.
  • Step 10: Closure Chest tubes are placed as needed to facilitate drainage, and the chest incision is subsequently closed to complete the procedure.

3. Post-Procedure

After the suture repair of the aorta or great vessels with shunt bypass, careful monitoring is essential to assess the patient's recovery. The placement of chest tubes may be necessary to manage any potential fluid accumulation or air leaks in the thoracic cavity. Patients will typically require close observation in a critical care setting to monitor vital signs, hemodynamic stability, and any signs of complications such as bleeding or infection. The recovery process may vary depending on the extent of the injury and the complexity of the repair, but patients can expect a gradual return to normal activities as they heal. Follow-up imaging studies may be performed to ensure the integrity of the repair and to monitor for any potential complications.

Short Descr REPAIR MAJOR VESSEL
Medium Descr SUTR RPR AORTA/GREAT VESSEL W/SHUNT BYPASS
Long Descr Suture repair of aorta or great vessels; with shunt bypass
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P2F - Major procedure, cardiovascular-Other
MUE 1
CCS Clinical Classification 61 - Other OR procedures on vessels other than head and neck

This is a primary code that can be used with these additional add-on codes.

33257 Addon Code MPFS Status: Active Code APC C Illustration for Code Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), limited (eg, modified maze procedure) (List separately in addition to code for primary procedure)
33258 Addon Code MPFS Status: Active Code APC C Illustration for Code Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (eg, maze procedure), without cardiopulmonary bypass (List separately in addition to code for primary procedure)
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
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1995-01-01 Added First appearance in code book in 1995.
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