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The CPT® Code 33886 refers to the procedure involving the delayed placement of a distal extension prosthesis following an endovascular repair of the descending thoracic aorta. This procedure is typically indicated when complications arise from the initial repair, such as the presence of an endoleak, which is a condition where blood leaks back into the aneurysm sac, or when there is migration of the endovascular components that poses a risk of developing an endoleak. Additionally, it may be necessary when there is an extension of the aneurysm distally. The procedure begins with the puncture of an access artery, commonly the femoral or iliac artery, through which a flexible guidewire is introduced in a retrograde manner into the ascending aorta, utilizing fluoroscopic guidance that is reported separately. This is followed by puncturing the contralateral femoral or iliac artery, placing a sheath, and advancing a second guidewire into the ascending aorta. An aortogram is then performed to evaluate the aneurysm, and an ultrasound probe is used to measure the distal extension site. The selection of a properly sized stent-graft extension prosthesis is crucial for the success of the procedure. The flexible guidewire is exchanged for a stiffer one, and the sheath is replaced with an introducer sheath to facilitate the loading and positioning of the stent-graft extension prosthesis. After deploying the prosthesis, the overlapping segments are ballooned and sealed to ensure a secure fit, and additional segments may be added as necessary. The procedure concludes with another aortogram to confirm the complete exclusion of the defect in the descending thoracic aorta and to check for any potential leakage.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 33886 is indicated under specific circumstances related to complications following an endovascular repair of the descending thoracic aorta. The following conditions warrant the performance of this procedure:
The procedure for the placement of a distal extension prosthesis involves several critical steps that ensure the successful repair of the descending thoracic aorta. The first step involves puncturing an access artery, typically the femoral or iliac artery, to gain access to the vascular system. A flexible guidewire is then passed in a retrograde fashion into the ascending aorta, utilizing fluoroscopic guidance, which is a separate reportable service. Following this, the contralateral femoral or iliac artery is punctured, and a sheath is placed to facilitate further access. A second guidewire is advanced into the ascending aorta through this sheath. An aortogram is performed to visualize the aneurysm and assess its characteristics. To accurately measure the distal extension site, an ultrasound probe is introduced. Based on these measurements, a properly sized stent-graft extension prosthesis is selected to ensure a secure fit. Once the appropriate prosthesis is chosen, one of the flexible guidewires is removed and exchanged for a stiffer guidewire, which provides better support during the placement of the prosthesis. One of the sheaths is then removed and replaced with an introducer sheath, which is designed to facilitate the loading and positioning of the stent-graft extension prosthesis. The prosthesis is carefully loaded and maneuvered into the correct position within the aorta. To confirm the accurate placement of the extension prosthesis, another aortogram is obtained. Upon verification of correct positioning, the stent-graft extension prosthesis is deployed. The overlapping segment between the original stent-graft and the newly placed distal extension prosthesis is then ballooned and sealed to ensure a tight fit. The distal end of the extension prosthesis is also ballooned and sealed to the aorta to prevent any potential leaks. If necessary, additional segments of the prosthesis may be added, each being ballooned and sealed as required. Finally, once all distal extensions are in place, a final aortogram is performed to verify the complete exclusion of the defect in the descending thoracic aorta and to check for any signs of leakage.
Post-procedure care following the placement of a distal extension prosthesis involves monitoring the patient for any complications that may arise from the procedure. This includes checking for signs of endoleak, ensuring that the stent-graft is functioning properly, and monitoring the patient's vital signs. Patients may require imaging studies, such as follow-up aortograms or ultrasounds, to assess the integrity of the repair and to confirm that there are no leaks or other complications. Recovery may vary depending on the individual patient's condition and the extent of the procedure performed. It is essential for healthcare providers to provide appropriate instructions for post-operative care, including activity restrictions and signs of potential complications that the patient should report. Regular follow-up appointments are crucial to ensure the long-term success of the procedure and to address any issues that may arise during the recovery period.
| Short Descr | ENDOVASC PROSTH DELAYED | Medium Descr | PLMT DSTL XTN PROSTH DLYD AFTER EVASC RPR DTA | Long Descr | Placement of distal extension prosthesis(s) delayed after endovascular repair of descending thoracic aorta | 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 52 - Aortic resection, replacement or anastomosis |
This is a primary code that can be used with these additional add-on codes.
| 34713 | Addon Code MPFS Status: Active Code APC N ASC N1 Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 French or larger), including ultrasound guidance, when performed, unilateral (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) | 34715 | Addon Code MPFS Status: Active Code APC N ASC N1 Open axillary/subclavian artery exposure for delivery of endovascular prosthesis by infraclavicular or supraclavicular 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) | 34812 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral (List separately in addition to code for primary procedure) | 34820 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular therapy, by abdominal or retroperitoneal 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) | 34834 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open brachial artery exposure for delivery of endovascular prosthesis, unilateral (List separately in addition to code for primary procedure) | 37252 | Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) | 37253 | Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (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). | AG | Primary physician | 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 | 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 |
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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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