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The procedure described by CPT® Code 33910 refers to a pulmonary artery embolectomy performed with the assistance of cardiopulmonary bypass. This surgical intervention is aimed at removing an embolus, which is a blockage in the pulmonary arteries that can impede blood flow to the lungs. The procedure typically involves accessing the pulmonary arteries through a median sternotomy or thoracotomy, which are surgical approaches that allow the surgeon to reach the heart and lungs effectively. During the operation, the main pulmonary artery and its branches are carefully dissected from the surrounding tissues to provide clear access for the removal of the embolus. If cardiopulmonary bypass is utilized, it involves cannulating the aorta and the superior and inferior vena cava to divert blood flow, allowing the heart and lungs to be temporarily bypassed while the surgery is performed. The pericardium, which is the protective sac surrounding the heart, is incised to facilitate access to the main pulmonary artery, which is then opened to locate and remove the embolus. This procedure is critical in restoring normal blood flow and preventing further complications associated with pulmonary embolism.
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The pulmonary artery embolectomy procedure is indicated for patients who present with a pulmonary embolism, which is a blockage in the pulmonary arteries typically caused by blood clots. This condition can lead to significant respiratory distress and cardiovascular instability. The procedure is particularly warranted when the embolus is large or when there is a failure of conservative management strategies, such as anticoagulation therapy, to resolve the blockage. Patients may exhibit symptoms such as sudden shortness of breath, chest pain, rapid heart rate, or low blood oxygen levels, necessitating urgent intervention to restore adequate blood flow to the lungs.
The pulmonary artery embolectomy procedure involves several critical steps to ensure successful removal of the embolus. First, the surgical team accesses the pulmonary arteries through a median sternotomy or thoracotomy, which allows for direct visualization and manipulation of the heart and lungs. Once access is achieved, the main pulmonary artery and its branches are meticulously dissected free from surrounding tissues to facilitate the next steps of the procedure. If cardiopulmonary bypass is indicated, the aorta and the superior and inferior vena cava are cannulated to establish the bypass, allowing blood to be diverted away from the heart and lungs. This step is crucial as it provides a bloodless field for the surgeon to work in. Following the establishment of cardiopulmonary bypass, the pericardium is incised to expose the heart, and the main pulmonary artery is opened. The incision may be extended into the right and/or left pulmonary arteries as necessary to locate the embolus. Once the embolus is identified, it is carefully removed to restore normal blood flow through the pulmonary arteries.
After the pulmonary artery embolectomy, patients are typically monitored closely in a postoperative setting, often in an intensive care unit, due to the nature of the procedure and the potential for complications. Recovery may involve managing pain, monitoring vital signs, and ensuring adequate respiratory function. Patients may require supplemental oxygen and will be assessed for any signs of bleeding or infection at the surgical site. The duration of the hospital stay can vary based on the patient's overall health and the complexity of the procedure, but careful follow-up is essential to ensure proper recovery and to address any potential complications that may arise following the surgery.
| Short Descr | REMOVE LUNG ARTERY EMBOLI | Medium Descr | PULMONARY ARTERY EMBOLECTOMY W/CARD BYPASS | Long Descr | Pulmonary artery embolectomy; with cardiopulmonary bypass | 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) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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 | 1 | CCS Clinical Classification | 61 - Other OR procedures on vessels other than head and neck |
This is a primary code that can be used with these additional add-on codes.
| 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) | 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) | 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) | 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) |
| 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). | 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). | 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 | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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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