2025 CPT code 33858
(Active) Effective Date: N/A Revision Date: N/A Surgery - Aortic Graft Procedures Cardiovascular System Feed
Ascending aorta graft placement with cardiopulmonary bypass, including valve suspension if performed, for aortic dissection.
Modifiers may be applicable depending on circumstances. For instance, modifier 58 might be used if there was a staged procedure, or modifier 62 if two surgeons were involved.
Surgical intervention is medically necessary for acute aortic dissections to prevent life-threatening complications such as aortic rupture, cardiac tamponade, stroke, or death. For chronic dissections, surgery may be indicated to prevent progression, or complications.Documentation should justify the surgical intervention based on clinical presentation, imaging findings, and hemodynamic parameters.
The cardiac surgeon is responsible for the surgical procedure, including pre-operative assessment, intra-operative management, and post-operative care. Anesthesiologists manage anesthesia, perfusionists operate the cardiopulmonary bypass machine, and other support staff provide needed assistance.
In simple words: The doctor repairs a torn section of the aorta (the body's largest artery) using a synthetic tube (graft). A heart-lung machine keeps the blood flowing while the doctor works.
This CPT code, 33858, describes the surgical procedure of grafting the ascending aorta with the use of cardiopulmonary bypass (CPB).The procedure involves the excision of the diseased portion of the ascending aorta and its replacement with a synthetic graft.The procedure may also include suspension of the aortic valve to an optimal position within the grafted vessel.The use of CPB is integral to the procedure, allowing for a bloodless surgical field and maintaining circulatory function.This code is specifically for cases of aortic dissection.
Example 1: A 65-year-old male presents with acute aortic dissection involving the ascending aorta.The surgeon performs an ascending aorta graft using CPB and suspends the aortic valve. Code 33858 is reported., A 72-year-old female with chronic aortic dissection requiring urgent surgical intervention undergoes ascending aorta replacement. CPB is used, and the aortic valve is successfully suspended during the graft placement. 33858 is the appropriate code., A 50-year-old male with a Stanford type A aortic dissection undergoes an emergent ascending aortic replacement with a composite Dacron graft.Cardiopulmonary bypass was utilized and the aortic valve was repositioned.Code 33858 applies.
Complete operative report detailing the procedure performed including the approach used, the type and length of the graft, the use of cardiopulmonary bypass, the status of the aortic valve (whether suspended or not), and any complications encountered. Preoperative and postoperative echocardiograms (or other imaging) demonstrating the extent of the dissection and the effectiveness of the repair are also necessary.Documentation of medical necessity should include evidence of hemodynamic instability or organ dysfunction due to the dissection.
** The specific details of the procedure, including the type of graft material used and the method of aortic valve suspension, may influence the selection of additional codes.Always refer to the most recent CPT manual for detailed coding guidelines and any updates.
- Revenue Code: P2A (Major Procedure, Cardiovascular)
- RVU: This information requires further research; RVUs vary based on geographic location and other factors.
- Global Days: Requires further research based on specific payer and location.
- Payment Status: Active
- Modifier TC rule: This information is not readily available in this context and requires additional research, as the TC modifier is context-specific.
- Fee Schedule: Requires further research; historical fee schedules vary by payer and location.Refer to CMS and payer websites for this historical data.
- Specialties:Cardiothoracic Surgery, Cardiac Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center