CPT® Code 33894

Official Description

Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; across major side branches

Common Language Description

The procedure described by CPT® Code 33894 involves the endovascular stent repair of coarctation, which refers to a narrowing of the aorta, a major blood vessel that carries oxygenated blood from the heart to the rest of the body. This specific procedure targets coarctation occurring in the ascending, transverse, or descending thoracic or abdominal aorta. The endovascular approach utilizes a catheter, which is a thin, flexible tube that is inserted into the body through a small incision, typically in the groin area. This method allows for the placement of a stent, a mesh-like device, to widen the narrowed section of the aorta. The coarctation of the aorta is often congenital, meaning it is present at birth, but symptoms may not manifest until later in life. In some instances, the narrowing can result from other factors such as trauma, severe atherosclerosis, or inflammation. The endovascular stent repair is performed under imaging guidance, ensuring precise placement of the catheter and stent. The deployment of a balloon at the tip of the catheter expands the narrowed area, and the stent is then positioned to keep the artery open. This minimally invasive technique is generally preferred over traditional open surgery due to its reduced recovery time and lower risk of complications. However, there remains a possibility that the coarctation may recur, necessitating further intervention. The procedure is critical in preventing serious complications associated with untreated aortic coarctation, which can include life-threatening conditions such as heart failure, stroke, and aneurysms.

1. Indications

The endovascular stent repair of coarctation of the aorta, as described by CPT® Code 33894, is indicated for patients presenting with the following conditions:

Coarctation of the Aorta - A narrowing of the aorta that can lead to significant cardiovascular complications if left untreated.
Congenital Aortic Coarctation - A condition present at birth that may not become symptomatic until later in life.
Acquired Aortic Coarctation - Coarctation resulting from trauma, severe atherosclerosis, or inflammation.

2. Procedure

The procedure for endovascular stent repair of coarctation of the aorta involves several critical steps:

Step 1: Access Site Preparation - The procedure begins with the preparation of the access site, typically the iliac artery located in the groin. The area is cleaned and sterilized to minimize the risk of infection.
Step 2: Catheter Insertion - A catheter is inserted into the iliac artery through the access point. This catheter is a thin, flexible tube that will be used to navigate through the vascular system.
Step 3: Navigation to the Aorta - Under imaging guidance, the catheter is carefully threaded through the blood vessels until it reaches the aorta. This step requires precision to ensure that the catheter is positioned correctly at the site of the coarctation.
Step 4: Balloon Deployment - Once the catheter is in place, a balloon at the tip of the catheter is deployed. This balloon is inflated to expand the narrowed section of the aorta, effectively widening the passage for blood flow.
Step 5: Stent Placement - After the balloon has expanded the artery, a mesh stent is placed at the site of the coarctation. The stent is designed to maintain the newly expanded diameter of the aorta and prevent re-narrowing.
Step 6: Catheter Removal - Following the successful placement of the stent, the catheter is carefully removed from the body, and the access site is closed and bandaged.

3. Post-Procedure

After the endovascular stent repair procedure, patients are typically monitored for a short period to ensure there are no immediate complications. Recovery is generally quicker compared to open surgical methods, with many patients able to resume normal activities within a few days. However, it is essential for patients to follow up with their healthcare provider for ongoing monitoring of the stent and the aorta to assess for any potential re-narrowing or other complications. Patients may also be advised on lifestyle modifications and medications to support cardiovascular health.

Short Descr	EVASC ST RPR THRC/AA ACRS BR
Medium Descr	EVASC ST RPR COARCJ THRC/AA ACRS MAJ SIDE BRNCH
Long Descr	Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; across major side branches
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)	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)	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)	none
MUE	1

This is a primary code that can be used with these additional add-on codes.

93568	Addon Code MPFS Status: Active Code APC N ASC N1 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for nonselective pulmonary arterial angiography (List separately in addition to code for primary procedure)
93569	Add-on Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, unilateral (List separately in addition to code for primary procedure)
93573	Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, bilateral (List separately in addition to code for primary procedure)
93574	Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary venous angiography of each distinct pulmonary vein during cardiac catheterization (List separately in addition to code for primary procedure)
93575	Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary angiography of major aortopulmonary collateral arteries (MAPCAs) arising off the aorta or its systemic branches, during cardiac catheterization for congenital heart defects, each distinct vessel (List separately in addition to code for primary procedure)

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)