2025 CPT code 33866
(Active) Effective Date: N/A Surgery - Cardiovascular Feed
Aortic hemiarch graft, including isolation and control of arch vessels, beveled open distal aortic anastomosis extending under one or more arch vessels, and total circulatory arrest or isolated cerebral perfusion.
Modifiers may be applicable in certain situations, such as reduced services (52), discontinued procedures (53), or staged procedures (58), etc.
Medical necessity for 33866 is established by documentation demonstrating the presence of ascending aortic disease involving the aortic arch, requiring a hemiarch graft in conjunction with the primary ascending aortic procedure.
The surgeon performs this procedure during open-heart surgery. It involves cannulating major blood vessels, initiating cardiopulmonary bypass, and carefully dissecting and grafting the damaged portion of the aortic arch.Precise surgical technique is required to create the beveled anastomosis without a cross-clamp while ensuring cerebral protection.
In simple words: During a major heart surgery, this procedure involves replacing part of the main artery coming from the heart (aorta) with a graft.This is done to repair a damaged section of the aorta, especially where smaller arteries branch off.The surgery requires stopping blood flow briefly and using special techniques to make sure the brain gets enough blood and oxygen.
This add-on code describes a procedure where a graft is placed in a portion of the aortic arch, extending under one or more of the branching vessels.It involves isolating and controlling the blood flow of the arch vessels, often employing total circulatory arrest or isolated cerebral perfusion to protect brain function during the procedure. The distal anastomosis is beveled and open, without the use of a cross-clamp.
Example 1: A patient with an ascending aortic dissection extending into the arch undergoes surgery, including an aortic hemiarch graft (33866) in addition to ascending aorta graft replacement (e.g., 33858)., A patient with a traumatic aortic arch injury requires a hemiarch graft (33866) along with repair of other damaged structures., A patient with Marfan syndrome develops an aortic arch aneurysm, requiring a hemiarch graft (33866) along with ascending aortic repair.
Documentation should include details of the primary procedure, the extent of the arch involvement, the type of cerebral protection used (total circulatory arrest or isolated cerebral perfusion), the method of anastomosis, and intraoperative findings.
- Revenue Code: P2F - Major Procedure, Cardiovascular - Other
- Specialties:Cardiothoracic Surgery, Vascular Surgery
- Place of Service:Inpatient Hospital