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An open coronary endarterectomy is a surgical procedure aimed at removing atheromatous plaque from the coronary arteries, specifically the left anterior descending, circumflex, or right coronary artery. This procedure is performed using any method during a coronary artery bypass graft (CABG) operation, which is a separate and reportable procedure. The need for coronary endarterectomy typically arises in patients with diffuse atherosclerotic coronary artery disease, where the arteries are narrowed or blocked due to the buildup of fatty deposits. During the procedure, the surgeon explores the coronary artery using finger palpation to assess the extent of the disease. An incision is made in the arterial wall to access and remove the atheromatous core, which may involve extending the arteriotomy to inspect major branches and ensure thorough plaque removal. Various techniques can be employed for plaque extraction, including eversion-type endarterectomy or direct vision methods. After the plaque is removed, the arteriotomy is closed with sutures or a patch made from a saphenous vein. It is important to note that if multiple vessels are treated during the procedure, the coronary endarterectomy should be reported separately for each vessel involved.
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The procedure of coronary endarterectomy is indicated for patients who exhibit the following conditions:
The procedure of coronary endarterectomy involves several critical steps that ensure the effective removal of atheromatous plaque from the coronary arteries:
Post-procedure care for patients who have undergone coronary endarterectomy typically involves monitoring for any complications related to the surgery, such as bleeding or infection. Patients may also require follow-up imaging studies to assess the patency of the treated arteries. Recovery may vary depending on the extent of the procedure and the patient's overall health, but generally, patients are advised to follow a cardiac rehabilitation program to promote recovery and improve cardiovascular health. It is essential for healthcare providers to provide detailed instructions regarding activity restrictions and medication management during the recovery phase.
| Short Descr | OPEN CORONARY ENDARTERECTOMY | Medium Descr | CORONARY ENDARTERCOMY OPEN ANY METHOD | Long Descr | 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) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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) | P2F - Major procedure, cardiovascular-Other | MUE | 3 | CCS Clinical Classification | 49 - Other OR heart procedures |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 33510 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Coronary artery bypass, vein only; single coronary venous graft | 33511 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Coronary artery bypass, vein only; 2 coronary venous grafts | 33512 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Coronary artery bypass, vein only; 3 coronary venous grafts | 33513 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Coronary artery bypass, vein only; 4 coronary venous grafts | 33514 | MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Coronary artery bypass, vein only; 5 coronary venous grafts | 33516 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Coronary artery bypass, vein only; 6 or more coronary venous grafts | 33533 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Coronary artery bypass, using arterial graft(s); single arterial graft | 33534 | MPFS Status: Active Code APC C Physician Quality Reporting Coronary artery bypass, using arterial graft(s); 2 coronary arterial grafts | 33535 | MPFS Status: Active Code APC C Physician Quality Reporting Coronary artery bypass, using arterial graft(s); 3 coronary arterial grafts | 33536 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Coronary artery bypass, using arterial graft(s); 4 or more coronary arterial grafts |
| AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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). | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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. | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | LC | Left circumflex coronary artery | LD | Left anterior descending coronary artery | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RC | Right coronary artery | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 1995-01-01 | Added | First appearance in code book in 1995. |
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