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The aortic hemiarch is a critical segment of the aorta, specifically the portion from which the innominate artery, left common carotid artery (LCCA), and left subclavian artery (LSCA) originate. This area is essential for supplying blood to the brain and upper body. Aortic hemiarch grafting is a surgical procedure performed to repair this segment, particularly when an aneurysm extends into the aortic hemiarch, necessitating intervention alongside ascending aorta repair. The procedure involves the isolation and control of the arch vessels to ensure a safe surgical environment. During the operation, total circulatory arrest or isolated cerebral perfusion techniques are employed to maintain blood flow to the brain while the graft is placed. This is crucial for preventing neurological damage during the repair process. The surgical technique includes creating a beveled open distal aortic anastomosis, which is the connection between the graft and the aorta, extending under one or more of the arch vessels. This procedure is typically performed in conjunction with other cardiac surgeries and is billed separately from the primary procedure, reflecting its complexity and the specialized care required for successful outcomes.
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The aortic hemiarch graft procedure is indicated for specific conditions that compromise the integrity of the aortic hemiarch. These include:
The aortic hemiarch graft procedure involves several critical steps to ensure successful repair of the aortic segment. The procedure begins with the isolation and control of the arch vessels, which is essential for maintaining hemostasis and protecting the surrounding structures during surgery. This is followed by the establishment of total circulatory arrest or isolated cerebral perfusion, techniques that are vital for preserving cerebral blood flow while the surgical repair is performed. The surgeon then inspects the aortic arch and frees the proximal aortic arch from surrounding tissue to facilitate access for the hemiarch repair. Next, the aorta is beveled to create a suitable surface for the anastomosis, which is the surgical connection between the graft and the aorta. The graft is then sized and trimmed to match the aorta's dimensions before being anastomosed using sutures. Following this, the false lumen is closed to prevent complications, and the anastomosis is reinforced externally with Teflon felt to enhance stability. Once the graft is in place, air is removed from the graft lumen to prevent air embolism, and artery clamps are released, allowing blood to fill the arch and proximal aorta. A vent in the anterior graft is utilized to eliminate residual air effectively. After confirming that full blood flow through the repaired vessel is restored, core temperature warming is initiated to stabilize the patient's condition. Finally, once satisfactory warming is achieved, cardiac ejection is activated, the patient is weaned from cardiopulmonary bypass, and the chest incision is closed.
Post-procedure care following an aortic hemiarch graft is critical for patient recovery and monitoring. Patients are typically transferred to an intensive care unit for close observation. Monitoring includes assessing vital signs, neurological status, and hemodynamic stability. Patients may require pain management and support for respiratory function as they recover from anesthesia and the surgical procedure. The surgical site will be monitored for signs of infection or complications. Follow-up imaging may be necessary to evaluate the integrity of the graft and ensure proper blood flow. Rehabilitation and gradual return to normal activities will be discussed as part of the recovery plan, tailored to the individual patient's needs and overall health status.
| Short Descr | AORTIC HEMIARCH GRAFT | Medium Descr | AORTIC HEMIARCH GRAFT W/ISOL & CTRL ARCH VESSELS | Long Descr | Aortic hemiarch graft including isolation and control of the arch vessels, beveled open distal aortic anastomosis extending under one or more of the arch vessels, and total circulatory arrest or isolated cerebral perfusion (List separately in addition to code for 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) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 1 - Team surgeons could be paid, though... | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 33858 | MPFS Status: Active Code APC C Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic dissection | 33859 | MPFS Status: Active Code APC C Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic disease other than dissection (eg, aneurysm) | 33863 | MPFS Status: Active Code APC C CPT Assistant Article Ascending aorta graft, with cardiopulmonary bypass, with aortic root replacement using valved conduit and coronary reconstruction (eg, Bentall) | 33864 | MPFS Status: Active Code APC C Ascending aorta graft, with cardiopulmonary bypass with valve suspension, with coronary reconstruction and valve-sparing aortic root remodeling (eg, David Procedure, Yacoub 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) | 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) |
| 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 | 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). | 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. | 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. | 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.) | AG | Primary physician | CR | Catastrophe/disaster related | ET | Emergency services | GW | Service not related to the hospice patient's terminal condition | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | 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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| 2019-01-01 | Added | Added |
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