2025 CPT code 33518

Coronary artery bypass using venous and arterial grafts; two venous grafts.This code is an add-on and must be used with codes 33533-33536.

Follow current CPT coding guidelines for coronary artery bypass grafting procedures.Ensure proper documentation supports the medical necessity and accurate coding of the procedure. Adhere to all payer-specific coding rules.

Modifiers 51 (multiple procedures), 59 (distinct procedural service), 78 (unplanned return to OR), 80 (assistant surgeon) may be applicable depending on the circumstances of the procedure.Always refer to the CPT manual and payer-specific guidelines for proper modifier use.

Medical necessity is established by the presence of significant coronary artery disease documented through non-invasive or invasive testing, such as coronary angiography, demonstrating hemodynamically significant stenosis and resulting in angina, myocardial ischemia, or heart failure. The procedure should be performed based on the patient's overall health status and the risks and benefits of the surgery, according to established clinical guidelines.

The clinical responsibility includes pre-operative assessment, harvesting of venous grafts (typically saphenous vein), preparation of grafts, anastomosis of the grafts to the coronary arteries and aorta, surgical closure, post-operative care, and monitoring of the patient’s condition. The surgeon is responsible for performing the bypass procedure, including proper graft selection, preparation, and placement.

IMPORTANT This code (33518) must be used with codes 33533-33536 (arterial graft codes).Additional codes may be necessary depending on the specific procedures performed, such as harvesting of upper extremity arteries (33509 or 35600), upper extremity veins (35500), or femoropopliteal vein segments (35572).

In simple words: This code describes a heart surgery where the doctor uses veins from the leg and arteries to create new pathways for blood to flow around blocked areas in the heart.Two vein grafts are used, and this code is added to another code that describes the artery part of the surgery.

This CPT code, 33518, reports coronary artery bypass grafting utilizing both venous and arterial grafts, specifically involving two venous grafts.This is an add-on code; it cannot stand alone and requires the reporting of an appropriate arterial graft code (33533-33536) in conjunction with it. The procurement of the saphenous vein graft is included in the procedure and should not be billed separately. The procedure involves harvesting venous grafts, typically from the saphenous vein in the leg, preparing them for grafting, anastomozing the distal ends to the diseased coronary arteries, and connecting the proximal ends to the aorta. The procedure is performed as part of a combined arterial and venous coronary artery bypass grafting procedure.

Example 1: A 65-year-old male patient presents with significant coronary artery disease.Cardiac catheterization reveals severe stenosis in the left anterior descending artery and the right coronary artery. The surgeon performs a coronary artery bypass graft using one arterial graft (internal mammary artery) and two venous grafts (saphenous vein). Codes 33533 and 33518 would be reported., A 72-year-old female patient undergoes a CABG procedure. The surgical team harvests the radial artery and two segments of the saphenous vein. One arterial graft is used, and two venous grafts are anastomosed to bypass the diseased coronary vessels.Codes 33509, 33533, and 33518 would be reported. , A 58-year-old male patient with multivessel coronary artery disease undergoes a CABG. The surgical team uses the left internal mammary artery and two segments of the saphenous vein as grafts.The surgeon performs the operation using cardiopulmonary bypass. Codes 33533, 33518 are reported.

Operative report clearly documenting the use of both arterial and venous grafts, the number of each type of graft used, the specific arteries grafted, and the location(s) of the harvested graft(s).Preoperative assessment, including cardiac catheterization results and coronary angiograms.Intraoperative details, such as the use of cardiopulmonary bypass, cardioplegia, and the duration of the procedure. Postoperative recovery notes, including hemodynamic stability and evidence of successful revascularization.

** Accurate coding of 33518 requires meticulous documentation of the entire procedure, including the arterial grafting component, which is billed separately using codes 33533-33536.Always verify coding with the most up-to-date CPT manual and payer guidelines.

  • Revenue Code: P2A (Major Procedure, Cardiovascular - CABG)
  • RVU: RVUs will vary based on geographic location, facility type, and other factors. Consult your local Medicare fee schedule or other payer-specific guidelines for accurate RVU values.
  • Global Days : The global period for this procedure is dependent on the primary procedure code used in conjunction with 33518. Consult the global surgical package guidelines for the specific arterial graft procedure code used.
  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Fee Schedule : Historical fee schedule data will vary significantly by location, payer, and year. Refer to specific payer fee schedules for this information.
  • Specialties:Cardiovascular Surgery, Cardiac Surgery
  • Place of Service:Inpatient Hospital, Ambulatory Surgical Center
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