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The procedure described by CPT® Code 33300 involves the repair of a cardiac wound without the use of cardiopulmonary bypass, commonly referred to as off-pump cardiac wound repair. This surgical intervention is necessary when there is a breach in the cardiac tissue, which can occur due to trauma or surgical complications. The process begins with the opening of the chest cavity to gain access to the heart, allowing the surgeon to control any bleeding and assess the extent of the cardiac injury. During this procedure, blood is evacuated from the thoracic cavity to provide a clear view of the surgical site. The pericardium, which is the fibrous sac surrounding the heart, may be incised to facilitate the drainage of any fluid accumulation in the pericardial cavity. To stabilize the heart during the repair, an apical traction suture, also known as a Beck's suture, is placed. This technique allows the surgeon to manipulate the heart while it continues to beat, which is crucial for identifying the exact location and severity of the wound. If the cardiac wound is small, bleeding can often be managed through direct digital pressure or temporary suturing. In cases where more significant bleeding occurs, a Foley catheter may be utilized; it is inserted through the wound into the cardiac chamber, and its balloon is inflated with normal saline to occlude the wound and reduce blood loss. For larger wounds, the surgical team may clamp the inferior and superior vena cava to create a bloodless field, enabling a more thorough evaluation of the wound and any potential damage to surrounding structures, including coronary arteries. Once the bleeding is controlled and no further injuries are detected, the wound is permanently closed using mattress sutures reinforced with pledgets to ensure stability and minimize the risk of future complications. Throughout the procedure, careful attention is paid to avoid damaging the coronary vessels. After the repair is completed, the traction suture is removed, and chest tubes may be placed as necessary before closing the chest cavity.
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The procedure described by CPT® Code 33300 is indicated for the repair of cardiac wounds that may arise from various causes, including but not limited to traumatic injuries, surgical complications, or other pathological conditions affecting the heart. The following conditions may warrant this procedure:
The procedure for the repair of a cardiac wound without bypass involves several critical steps to ensure effective management of the injury. The following procedural steps are outlined:
Post-procedure care following the repair of a cardiac wound without bypass involves monitoring the patient for any signs of complications, such as bleeding or infection. Patients may require close observation in a critical care setting to ensure stable hemodynamics and proper recovery. The placement of chest tubes allows for the drainage of any residual fluid or blood, which is essential for preventing complications such as cardiac tamponade. The recovery process may vary depending on the extent of the injury and the patient's overall health status. Follow-up imaging studies may be necessary to assess the integrity of the cardiac repair and ensure that no additional injuries have developed. Additionally, the healthcare team will provide guidance on activity restrictions and rehabilitation as the patient progresses in their recovery.
| Short Descr | REPAIR OF HEART WOUND | Medium Descr | REPAIR CARDIAC WOUND W/O BYPASS | Long Descr | Repair of cardiac wound; without 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) | 33258 | 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), without cardiopulmonary bypass (List separately in addition to code for primary procedure) |
| 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. | 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, 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 | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter |
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