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Coronary artery bypass graft (CABG) surgery is a critical procedure aimed at restoring blood flow to the heart by bypassing narrowed or blocked coronary arteries. The coronary arteries are essential as they supply oxygen and nutrients to the heart muscle. When these arteries become narrowed or blocked due to conditions such as atherosclerosis, it can lead to ischemic heart disease and potentially result in a myocardial infarction, commonly known as a heart attack. The CABG procedure involves the use of arterial grafts to reroute blood around the obstructed arteries, thereby improving blood flow to the heart. During the surgery, one or more arteries are harvested from the patient's body, with common sources including the internal mammary artery (IMA), the inferior epigastric artery (IEA), and the radial artery. These grafts can be harvested as pedicle grafts, which include surrounding tissues, or skeletonized, where all surrounding tissues are removed, leaving only the outer layer of the graft. The surgical approach typically involves a median sternotomy to access the thoracic cavity, allowing for the careful dissection and preparation of the grafts. The procedure can be performed using either an off-pump technique, where the heart continues to beat during surgery, or a cardiopulmonary bypass technique, where the heart is temporarily stopped and the patient is connected to a heart-lung machine. The ultimate goal of CABG is to enhance blood flow to the heart muscle, alleviate symptoms of coronary artery disease, and reduce the risk of future cardiac events.
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The procedure is indicated for patients with significant coronary artery disease characterized by the following conditions:
The CABG procedure involves several critical steps to ensure successful revascularization of the heart. The first step is the harvesting of arterial grafts, which may include the internal mammary artery (IMA), inferior epigastric artery (IEA), or radial artery. If the IMA is selected, a median sternotomy is performed to access the thoracic cavity. The pleura is carefully displaced laterally to allow for the identification and dissection of the IMA segment, which is typically harvested as a pedicle graft, including satellite veins and endothoracic fascia. The IMA is separated from the chest wall at the third or fourth intercostal space, and collateral branches in the distal portion are divided. The proximal portion of the IMA is inspected, and any collateral branches are also divided. Once the IMA graft is prepared, the surgical team may choose to perform the bypass using either the off-pump coronary artery bypass (OPCAB) technique or the cardiopulmonary bypass technique. If the OPCAB technique is utilized, the surgery is conducted on the beating heart after administering medication to slow the heart rate. Conversely, if cardiopulmonary bypass is initiated, the patient is connected to the bypass pump, and cardioplegia is administered to protect the heart during the procedure. The pericardium is incised, and the aorta is cannulated to facilitate the bypass. The distal end of the IMA is then divided, and the graft is rotated for optimal positioning. The inferior surface of the IMA is exposed by retracting and incising the endothoracic fascia. The proximal end of the graft is clamped, and the distal end is prepared for anastomosis using a papaverine solution flush and a papaverine-soaked gauze wrap. If the IEA is harvested, the abdomen is incised to expose the omentum, while the anterior rectus sheath is opened to access the IEA. The IEA may also be harvested as a pedicle graft or skeletonized. If an upper extremity artery, such as the radial artery, is used, it is harvested in a separately reportable procedure. The prepared arterial grafts are then sewn into place, attaching one end to the ascending aorta and the other end to the diseased coronary artery beyond the blockage. Finally, if cardiopulmonary bypass was used, it is discontinued to restore normal heart function.
Post-procedure care for patients undergoing CABG includes monitoring in a recovery unit to assess vital signs and ensure stable hemodynamics. Patients are typically observed for any signs of complications, such as bleeding or infection at the surgical site. Pain management is an essential aspect of post-operative care, and patients may be prescribed analgesics to manage discomfort. Rehabilitation and gradual resumption of physical activity are encouraged to promote recovery and improve cardiovascular health. Follow-up appointments are necessary to monitor the patient's progress and assess the patency of the grafts. Patients are also educated on lifestyle modifications, including dietary changes and smoking cessation, to support long-term heart health.
| Short Descr | CABG ARTERIAL FOUR OR MORE | Medium Descr | CABG W/ARTERIAL GRAFT FOUR/>ARTERIAL GRAFTS | Long Descr | Coronary artery bypass, using arterial graft(s); 4 or more coronary arterial grafts | 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) | 0 - Co-surgeons not permitted for this procedure. | 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) | P2A - Major procedure, cardiovascular-CABG | MUE | 1 | CCS Clinical Classification | 44 - Coronary artery bypass graft (CABG) |
This is a primary code that can be used with these additional add-on codes.
| 33141 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting PUB 100 CPT Assistant Article Transmyocardial laser revascularization, by thoracotomy; performed at the time of other open cardiac procedure(s) (List separately in addition to code for primary procedure) | 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) | 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) | 33517 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft (List separately in addition to code for primary procedure) | 33518 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Coronary artery bypass, using venous graft(s) and arterial graft(s); 2 venous grafts (List separately in addition to code for primary procedure) | 33519 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Coronary artery bypass, using venous graft(s) and arterial graft(s); 3 venous grafts (List separately in addition to code for primary procedure) | 33521 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Coronary artery bypass, using venous graft(s) and arterial graft(s); 4 venous grafts (List separately in addition to code for primary procedure) | 33522 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Coronary artery bypass, using venous graft(s) and arterial graft(s); 5 venous grafts (List separately in addition to code for primary procedure) | 33523 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Coronary artery bypass, using venous graft(s) and arterial graft(s); 6 or more venous grafts (List separately in addition to code for primary procedure) | 33530 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Reoperation, coronary artery bypass procedure or valve procedure, more than 1 month after original operation (List separately in addition to code for primary procedure) | 33572 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Coronary endarterectomy, open, any method, of left anterior descending, circumflex, or right coronary artery performed in conjunction with coronary artery bypass graft procedure, each vessel (List separately in addition to 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) | 35500 | Addon Code MPFS Status: Active Code APC N CPT Assistant Article Harvest of upper extremity vein, 1 segment, for lower extremity or coronary artery bypass procedure (List separately in addition to code for primary procedure) | 35572 | Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Harvest of femoropopliteal vein, 1 segment, for vascular reconstruction procedure (eg, aortic, vena caval, coronary, peripheral artery) (List separately in addition to code for primary procedure) | 35600 | Add-on Code Modifier 51 Exempt MPFS Status: Active Code APC C Illustration for Code Harvest of upper extremity artery, 1 segment, for coronary artery bypass procedure, open |
| 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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). | 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. | 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.) | 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). | AG | Primary physician | 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 | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study |
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| 2011-01-01 | Changed | Short description changed. |
| 2010-01-01 | Changed | Code description changed. |
| 1993-01-01 | Added | First appearance in code book in 1993. |
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