© Copyright 2025 American Medical Association. All rights reserved.
The procedure described by CPT® Code 33267 refers to the open exclusion of the left atrial appendage (LAA) using any method, which may include excision, isolation via stapling, oversewing, ligation, plication, or the application of a clip. This surgical intervention is primarily indicated for patients diagnosed with non-valvular atrial fibrillation (NVAF) who are at a heightened risk for thrombus formation or stroke, particularly when oral anticoagulation therapy is not a viable option. The LAA is a small, pouch-like structure located in the left atrium of the heart, and it can be a site for blood clots to form, which can lead to serious complications such as stroke. By performing an exclusion of the LAA, the procedure aims to completely close off or remove this anatomical structure, thereby preventing it from retaining blood and reducing the risk of clot development. The surgical approach can be either endocardial, which involves directly accessing the heart's interior to amputate the LAA, or epicardial, where closure methods are applied externally. The choice of technique may depend on various factors, including the unique anatomical variations of the LAA, which can be classified into four distinct morphological groups, as well as the patient's specific cardiac conditions and rhythm status. This code specifically applies when the LAA exclusion is the sole procedure conducted during the surgical encounter, distinguishing it from other related codes that may apply when performed alongside additional cardiac procedures.
© Copyright 2025 Coding Ahead. All rights reserved.
Non-Valvular Atrial Fibrillation (NVAF) The procedure is indicated for patients with NVAF who are at high risk for thrombus formation or stroke, particularly when oral anticoagulation therapy is contraindicated.
Step 1: Patient Preparation Prior to the procedure, the patient is prepared for surgery, which includes obtaining informed consent, performing necessary preoperative assessments, and ensuring that the patient is in a suitable condition for the surgical intervention.
Step 2: Anesthesia Administration The patient is administered appropriate anesthesia to ensure comfort and pain management throughout the procedure. This may involve general anesthesia or other forms of sedation, depending on the surgical approach and patient needs.
Step 3: Surgical Access The surgeon gains access to the heart, which may involve making an incision in the chest to reach the left atrium. This access is crucial for performing the exclusion of the LAA.
Step 4: LAA Exclusion The surgeon performs the exclusion of the left atrial appendage using one of several methods. In the endocardial approach, the atrium is opened, and the LAA is amputated before closing the remaining heart muscle. Alternatively, in the epicardial approach, closure methods such as sutures, staples, or clips are applied externally around the neck of the LAA to fully exclude it from the atrial cavity.
Step 5: Closure of Surgical Site After the LAA has been successfully excluded, the surgical site is carefully closed. This involves suturing the incision in the chest and ensuring that all layers of tissue are properly aligned and secured.
Step 6: Postoperative Monitoring Following the procedure, the patient is monitored in a recovery area to assess vital signs, manage pain, and observe for any immediate complications related to the surgery.
Post-procedure care involves monitoring the patient for any signs of complications, such as bleeding or infection at the surgical site. Patients may require follow-up imaging studies to confirm the successful exclusion of the LAA. Recovery time can vary based on the individual patient's health status and the complexity of the procedure, but patients are typically advised on activity restrictions and follow-up appointments to ensure proper healing and management of their atrial fibrillation.
| Short Descr | EXCL LAA OPEN ANY METHOD | Medium Descr | EXCLUSION LEFT ATRIAL APPENDAGE OPEN ANY METHOD | Long Descr | Exclusion of left atrial appendage, open, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip) | 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) | none | MUE | 1 |
| 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). | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 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. | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2022-01-01 | Added | Code added |
Get instant expert-level medical coding assistance.