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The procedure described by CPT® Code 33891 involves a bypass graft using a synthetic conduit, specifically performed in the transcervical retropharyngeal region between the carotid arteries. This surgical intervention is typically indicated for patients requiring vascular reconstruction in conjunction with an endovascular repair of the descending thoracic aorta. The operation begins with a bilateral incision in the neck, allowing for careful dissection to expose the carotid arteries while ensuring the protection of surrounding vessels and nerves. The common carotid arteries are then controlled using soft rubber loops to facilitate the surgical process. A tunnel is created behind the pharynx to enable the passage of the synthetic conduit, which is essential for establishing the bypass. Throughout the procedure, anticoagulation is administered intravenously to prevent thromboembolic complications. The surgical steps include clamping, incising, and anastomosing the common carotid arteries to the bypass conduit, followed by meticulous control of bleeding and verification of blood flow. The procedure concludes with the closure of the neck incisions, ensuring a secure and effective surgical outcome.
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The procedure described by CPT® Code 33891 is indicated for patients who require a bypass graft due to specific vascular conditions that necessitate the reconstruction of blood flow between the carotid arteries. This may include situations where there is significant stenosis or occlusion of the carotid arteries that could lead to compromised cerebral perfusion. Additionally, this procedure is performed in conjunction with an endovascular repair of the descending thoracic aorta, indicating a need for comprehensive vascular intervention in patients with complex aortic pathologies.
The surgical procedure begins with a bilateral incision in the neck, allowing access to the carotid arteries. The surgeon performs a careful soft tissue dissection to expose these arteries while taking care to mobilize and protect surrounding vessels and nerves. Once the carotid arteries are adequately exposed, the common carotid arteries are controlled by passing soft rubber loops around them both proximally and distally. This step is crucial for maintaining a clear surgical field and ensuring safety during the subsequent steps.
After the completion of the bypass graft procedure, patients are typically monitored for any signs of complications, such as bleeding or infection at the incision sites. The expected recovery involves close observation of neurological status to ensure adequate cerebral perfusion. Patients may require follow-up imaging studies to assess the patency of the bypass graft and the overall vascular status. Pain management and wound care are also essential components of post-procedure care. The surgical team will provide specific instructions regarding activity restrictions and follow-up appointments to ensure optimal recovery and monitoring of the surgical outcomes.
| Short Descr | CAR-CAR BP GRFT/ENDOVAS TAA | Medium Descr | BYP GRF W/DESCENDING THORACIC AORTA RPR NECK INC | Long Descr | Bypass graft, with other than vein, transcervical retropharyngeal carotid-carotid, performed in conjunction with endovascular repair of descending thoracic aorta, by neck incision | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | 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 | 59 - Other OR procedures on vessels of head and neck |
| 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). | 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). | 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 | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2006-01-01 | Added | First appearance in code book in 2006. |
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