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The procedure described by CPT® Code 33507 involves the surgical repair of an anomalous origin of a coronary artery from the aorta, specifically when the artery has an intramural course. This condition can lead to various complications, including myocardial ischemia, due to the abnormal positioning of the artery. The surgical approach typically begins with a median sternotomy, which is an incision made along the sternum to access the heart. Once the chest is opened, the surgeon places cardiac cannulas to initiate cardiopulmonary bypass, allowing for a controlled environment to perform the surgery while maintaining blood circulation and oxygenation. An aortic cross-clamp is then applied to stop blood flow through the aorta, and cardioplegic arrest is induced to protect the heart muscle during the procedure. The surgeon identifies the ostia, or opening, of the anomalous coronary artery, which is usually located near the commissure between the right and left cusps of the aortic valve. The coronary artery may have an intramural course, meaning it runs within the wall of the aorta, which necessitates careful dissection. The procedure may involve unroofing the coronary artery, which entails cutting the anterior wall of the artery to expose it properly. Alternatively, the artery may be translocated to a more anatomically correct position. This involves creating a window in the intima of the aorta and repositioning the artery accordingly. After the necessary adjustments are made, the aorta is closed, and the surgical team ensures that air is removed from the heart and aorta before gradually re-establishing blood flow. The procedure concludes with the insertion of chest tubes and temporary pacing wires, followed by the closure of the sternum. This complex surgical intervention aims to restore normal coronary artery function and prevent future cardiac complications.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 33507 is indicated for patients with an anomalous origin of a coronary artery from the aorta, particularly when the artery follows an intramural course. This condition can lead to significant cardiovascular issues, including myocardial ischemia, which may manifest as chest pain, shortness of breath, or other symptoms of reduced blood flow to the heart muscle. Surgical intervention is necessary to correct the anatomical abnormality and restore normal blood flow to the heart.
The surgical procedure begins with a median sternotomy, where the chest is opened to provide access to the heart. Following this, cardiac cannulas are placed to initiate cardiopulmonary bypass, which allows the surgeon to operate on a still and bloodless field. An aortic cross-clamp is applied to halt blood flow through the aorta, and cardioplegic arrest is achieved to protect the heart muscle during the operation. The surgeon then incises the aorta and identifies the ostia of the anomalous coronary artery, which is typically located near the commissure between the right and left cusps of the aortic valve. Once the ostia is located, the surgeon assesses the course of the coronary artery, which may be intramural, meaning it runs within the wall of the aorta. The next step involves unroofing the coronary artery, which requires transecting the anterior wall of the artery horizontally through the uppermost portion of the aortic valve commissure. This unroofing process exposes the artery and allows for further manipulation. If necessary, the commissure may be resuspended to maintain proper anatomical alignment. In some cases, instead of unroofing, the surgeon may choose to translocate the coronary artery to a more appropriate anatomical position. This involves creating a window in the intima of the aorta and repositioning the anomalous coronary artery accordingly. After the artery is properly situated, the incision in the aorta is closed securely. The surgical team then removes any air from the heart and aorta, carefully monitoring the patient as the cross-clamp is removed. The patient is gradually warmed, and once stable, they are taken off cardiopulmonary bypass. Finally, chest tubes are inserted to facilitate drainage, and temporary pacing wires are placed to manage the heart's rhythm if necessary. The procedure concludes with the closure of the sternum, ensuring that the patient is stable for recovery.
After the completion of the surgical procedure, the patient is closely monitored in a recovery setting. The insertion of chest tubes is crucial for draining any excess fluid or air that may accumulate in the thoracic cavity, which can help prevent complications such as pneumothorax or pleural effusion. Temporary pacing wires are also placed to manage the heart's rhythm, allowing for immediate intervention if arrhythmias occur. The expected recovery period will vary based on the individual patient's condition and the complexity of the surgery. Patients may experience pain and discomfort at the incision site, which can be managed with appropriate analgesics. Cardiac rehabilitation may be recommended to aid in recovery and improve cardiovascular health. Regular follow-up appointments will be necessary to monitor the patient's progress and ensure that the surgical repair is functioning as intended. Overall, the post-procedure care is essential for a successful recovery and to minimize the risk of complications.
| Short Descr | REPAIR ART INTRAMURAL | Medium Descr | RPR ANOM AORTIC ORIGIN CORONARY ART UNROOF/TLCJ | Long Descr | Repair of anomalous (eg, intramural) aortic origin of coronary artery by unroofing or translocation | 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) | P2B - Major procedure, cardiovascular-Aneurysm repair | 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) |
| 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). | 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. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 |
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| 2011-01-01 | Changed | Short description changed. |
| 2006-01-01 | Added | First appearance in code book in 2006. |
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