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The procedure described by CPT® Code 33261 involves the operative ablation of a ventricular arrhythmogenic focus, which is a specific site within the ventricles of the heart that generates abnormal electrical signals leading to ventricular tachycardia. This condition can result in rapid heartbeats that may compromise the heart's ability to pump blood effectively. The procedure is performed using cardiopulmonary bypass, a technique that temporarily takes over the function of the heart and lungs during surgery, allowing the surgeon to operate on a still and bloodless field. Access to the heart is achieved through a midline sternotomy, which involves making an incision along the sternum to provide direct access to the thoracic cavity. During the procedure, both epicardial and endocardial electrodes are placed on the heart to facilitate pacing and mapping, which are essential for accurately locating the arrhythmogenic focus. This mapping process helps identify the specific area responsible for the abnormal electrical activity. Once the focus is localized, cardiopulmonary bypass is established, and cardioplegic arrest is initiated to protect the heart muscle during the surgical intervention. The surgeon then makes an incision over the identified arrhythmogenic focus, where the abnormal electrical conduction pathway is either interrupted through surgical incision or destroyed using techniques such as cryoablation or radiofrequency ablation. After the ablation is completed, the heart incision is closed, and the cardiopulmonary bypass is discontinued. Finally, chest tubes may be placed as necessary to drain any fluid or air, and the chest incision is closed to complete the procedure.
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The operative ablation of a ventricular arrhythmogenic focus with cardiopulmonary bypass is indicated for patients experiencing episodes of ventricular tachycardia due to the presence of an abnormal or accessory electrical conduction site located in the ventricles. This procedure is typically considered when other treatment options, such as medication or less invasive interventions, have been ineffective in managing the arrhythmia. The goal of the procedure is to eliminate the source of the arrhythmia, thereby restoring normal heart rhythm and improving the patient's overall cardiac function.
The procedure begins with the patient being placed under general anesthesia, followed by a midline sternotomy to gain access to the thoracic cavity and the heart. Once the chest is opened, epicardial and endocardial electrodes are strategically placed on the beating heart. These electrodes are crucial for pacing and mapping the electrical activity of the heart, allowing the surgical team to accurately identify the arrhythmogenic focus. After the focus is localized, cardiopulmonary bypass is established, which involves connecting the patient to a heart-lung machine that takes over the functions of the heart and lungs. This allows the heart to be still and bloodless during the procedure. Cardioplegic arrest is then initiated, which involves administering a solution that temporarily stops the heart's activity to protect the myocardial tissue during surgery. With the heart in a state of cardioplegic arrest, the surgeon makes an incision over the identified arrhythmogenic focus. The focus is then either interrupted by surgical incision or destroyed using ablation techniques such as cryoablation or radiofrequency ablation. These methods effectively eliminate the abnormal electrical conduction pathway responsible for the arrhythmia. Once the ablation is completed, the heart incision is carefully closed, and the cardiopulmonary bypass is discontinued, allowing the heart to resume its normal function. Finally, chest tubes may be placed as needed to facilitate drainage of any fluid or air, and the chest incision is closed to complete the procedure.
After the procedure, patients are typically monitored in a recovery area or intensive care unit to ensure stable vital signs and to observe for any complications. The expected recovery period may vary depending on the individual patient's condition and the complexity of the procedure. Patients may experience some discomfort at the incision site, which can be managed with pain relief medications. Chest tubes, if placed, are monitored and removed once the output is minimal and the patient is stable. Follow-up appointments are essential to assess the success of the ablation and to monitor for any recurrence of arrhythmias. Patients may also undergo additional testing, such as an electrocardiogram (ECG), to evaluate heart rhythm post-procedure. It is important for patients to adhere to any prescribed medication regimens and lifestyle modifications to support their recovery and overall heart health.
| Short Descr | ABLATE HEART DYSRHYTHM FOCUS | Medium Descr | OPRATIVE ABLTJ VENTR ARRHYTHMOGENIC FOC W/BYPASS | Long Descr | Operative ablation of ventricular arrhythmogenic focus with cardiopulmonary 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 | 49 - Other OR heart procedures |
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) | 33259 | 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), with cardiopulmonary bypass (List separately in addition to code for primary procedure) | 34714 | Addon Code MPFS Status: Active Code APC N ASC N1 Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition to code for primary procedure) | 34716 | Addon Code MPFS Status: Active Code APC N ASC N1 Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure) | 34833 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open iliac artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by abdominal or retroperitoneal incision, unilateral (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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study |
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| 1990-01-01 | Added | First appearance in code book in 1990. |
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