CPT 33140 Laser Revascularization Reimbursement | OpenPayer

Summary & Overview

CPT 33140: Laser Revascularization of Heart via Thoracotomy

CPT code 33140 identifies laser revascularization of the heart performed through a thoracotomy. This surgical, cardiac revascularization code captures use of laser to create myocardial channels or otherwise restore blood flow via an open thoracic approach. The code matters nationally as it relates to specialty cardiac surgery billing, inpatient and hospital outpatient reimbursement, and classification of laser-assisted myocardial revascularization procedures.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise account of the code's clinical context, typical sites of service, and the payer landscape relevant to coverage and claims processing. The publication provides benchmark-oriented information, policy and coding considerations that affect billing and claims submission, and how this procedure is positioned within cardiac surgical services.

The audience will gain a practical snapshot of where CPT code 33140 fits in surgical service lines, what settings commonly deliver the service, and which major payers are relevant for coverage and claims. Data not available in the input will be explicitly noted where applicable in detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare33140CPTcardiac surgerylaser revascularizationthoracotomyhospital outpatientinpatient surgerycardiovascular procedures

Billing Code Overview

CPT code 33140 describes laser revascularization of the heart performed via thoracotomy. The procedure uses laser technology to restore or improve myocardial blood flow by creating channels in the myocardium through a surgical thoracotomy approach.

Service Type: Surgical, cardiac revascularization (laser-assisted)

Typical Site of Service: Inpatient or outpatient hospital surgical suite (thoracotomy approach)

Clinical & Coding Specifications

Clinical Context

A typical patient for 33140 is a 68-year-old male with refractory angina due to diffuse coronary artery disease not amenable to percutaneous coronary intervention or conventional coronary artery bypass grafting. He has progressive exertional chest pain despite maximal medical therapy and prior failed PCI attempts. Diagnostic workup includes coronary angiography confirming distal and intramyocardial vessel disease. The cardiac surgery team schedules a laser revascularization procedure performed via left thoracotomy under general anesthesia. Intraoperative workflow includes single-lung ventilation, median or anterolateral thoracotomy exposure of the pericardium, epicardial mapping to localize ischemic territories, application of the laser to create channels in the ischemic myocardium, hemostasis, chest tube placement, and layered closure. Postoperative care occurs in a cardiac intensive care or step-down unit with continuous telemetry, analgesia, respiratory support as needed, chest tube management, and monitoring for bleeding or myocardial injury. Discharge planning includes wound care, activity restrictions, cardiac rehabilitation referral, and outpatient cardiology follow-up for ischemic symptom reassessment.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or time for substantially exceeds typical expectations due to complexity.

CPT 33141: Laser Revascularization During Open Cardiac Procedure

33140

Taxonomy Code	Specialty	Notes
207RC0000X	Cardiac Surgery	Primary specialty performing thoracotomy and intracardiac procedures.
207L00000X	Thoracic Surgery	Performs thoracic approaches and may perform epicardial procedures.
207RN0300X	Cardiothoracic Surgery	Combined specialty designation for surgeons performing complex cardiac-thoracic operations.
207RG0300X	Cardiac Electrophysiology	May be involved for intraoperative epicardial mapping and localization of ischemic myocardium.
207RC0005X	Vascular Surgery	Occasionally involved when vascular access or adjunctive revascularization is required.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I20.1`	Unstable angina	Frequent indication for surgical myocardial revascularization when PCI is not feasible.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Underlying coronary artery disease leading to ischemia addressed by `33140`.
`I25.110`	Atherosclerotic heart disease of native coronary artery with unstable angina	Indicates active ischemia prompting revascularization procedures.
`I25.119`	Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris	Chronic angina refractory to medical therapy where laser revascularization may be considered.
`I50.9`	Heart failure, unspecified	Patients with ischemic cardiomyopathy and heart failure symptoms may be candidates when ischemia contributes to dysfunction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33210`	Insertion or replacement of permanent pacemaker with transvenous lead(s); single lead	Used pre- or postoperatively if intraoperative conduction issues or bradyarrhythmias require pacing support during `33140` recovery.
`33212`	Insertion or replacement of permanent pacemaker with transvenous lead(s); dual leads	Same context as `33210` when dual-chamber pacing is needed.
`33206`	Temporary transvenous pacing, insertion	Performed intraoperatively or postoperatively if temporary pacing required after myocardial manipulation during `33140`.
`32820`	Thoracotomy, with exploration, with or without biopsy	May be performed if additional thoracic exploration or biopsy is required in the same operative setting as `33140`.
`33285`	Insertion of temporary transvenous pacemaker, removal, and monitoring	Related to immediate perioperative cardiac rhythm management for patients undergoing `33140`.

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