CPT 33255 Atrial Reconstruction Reimbursement | OpenPayer

Summary & Overview

CPT 33255: Atrial Ablation and Reconstruction, Off‑Pump

CPT code 33255 denotes an off-pump surgical procedure that destroys extensive atrial tissue responsible for abnormal electrical activity and reconstructs both the left and right atria to treat atrial fibrillation. This invasive cardiac surgical ablation is clinically significant as a rhythm-control option for patients with complex or refractory atrial fibrillation who are candidates for open surgical intervention without cardiopulmonary bypass. Nationally, the code matters for hospitals and cardiovascular surgery programs managing resource use, operative planning, and documentation for complex arrhythmia care.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The content outlines clinical context, expected site-of-service considerations, and the administrative elements that affect coding and billing workflows.

Readers will find a concise overview of the clinical indication and procedure intent, descriptions of the typical service setting, and a guide to what to expect in related billing and policy materials. The publication summarizes benchmarks and payment policy context where available, highlights documentation priorities tied to the procedure description, and notes where input data was not provided. This national-level summary is intended for billing managers, cardiovascular surgeons, hospital administrators, and policy analysts seeking a clear understanding of CPT code 33255 and its role in managing atrial fibrillation with an off-pump surgical approach.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 33255atrial fibrillationcardiac surgerysurgical ablationatrial reconstructionoff-pump procedurecardiovascularoperating roomprocedure coding

Billing Code Overview

CPT code 33255 describes a surgical procedure in which the provider destroys extensive atrial tissue that is causing an abnormal heart rhythm and then reconstructs the left and right atria. The procedure is used to treat atrial fibrillation, a condition in which abnormal electrical signals cause the atria to contract rapidly and irregularly. The description specifies that the provider does not place the patient on cardiopulmonary bypass during the procedure.

Service Type: Cardiac surgical ablation with atrial reconstruction (off-pump)

Typical Site of Service: Hospital operating room or cardiovascular surgical suite

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with symptomatic persistent atrial fibrillation refractory to medical therapy and prior ineffective catheter ablation is scheduled for a surgical atrial fibrillation ablation without cardiopulmonary bypass. The patient has hypertension and nonobstructive coronary artery disease; preoperative evaluation includes transthoracic echocardiography showing preserved left ventricular function and left atrial enlargement. General anesthesia is administered in an operating room or hybrid electrophysiology suite. The surgeon performs an epicardial or endocardial lesion set to electrically isolate arrhythmogenic atrial tissue, destroying extensive atrial tissue (ablation) and reconstructing the left and right atria as needed to restore atrial geometry and conduction pathways. Intraoperative transesophageal echocardiography and continuous rhythm monitoring guide lesion placement. Hemostasis and atrial reconstruction are completed without instituting cardiopulmonary bypass. Postoperative care includes telemetry monitoring in a step-down unit or intensive care unit, anticoagulation management, and rhythm assessment before discharge. Typical sites of service are the main operating room or hybrid cardiac catheterization/electrophysiology suite.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure requires substantially greater effort, time, or complexity than typical.

CPT 33268: Left Atrial Appendage Exclusion, Open Cardiac Surgery

CPT-33261-CARDIAC-VENTRICULAR-ABLATION-CARDIOPULMONARY-BYPASS

CPT 33261: Surgical Ventricular Ablation with Cardiopulmonary Bypass

CPT-33257-ATRIAL-ABLATION-AND-RECONSTRUCTION-ADD-ON

CPT 33257: Atrial Tissue Ablation and Atrial Reconstruction (Add-On)

CPT-33251-CARDIAC-ABLATION-WITH-CARDIOPULMONARY-BYPASS

CPT 33251: Surgical Cardiac Ablation With Cardiopulmonary Bypass

CPT-33254-ATRIAL-ABLATION-AND-ATRIAL-RECONSTRUCTION

CPT 33254: Atrial Ablation with Left and Right Atrial Reconstruction

CPT-33250-CARDIAC-ARRHYTHMIA-ABLATION-NO-BYPASS

CPT 33250: Cardiac Arrhythmia Ablation Without Bypass

CPT-33256-ATRIAL-ABLATION-ATRIAL-RECONSTRUCTION

CPT 33256: Atrial Ablation with Left and Right Atrial Reconstruction

CPT-33259-EXTENSIVE-ATRIAL-ABLATION-AND-RECONSTRUCTION

CPT 33259: Extensive Atrial Ablation and Reconstruction

CPT-33264-IMPLANTABLE-DEFIBRILLATOR-PULSE-GENERATOR-REPLACEMENT-THREE-CHAMBER

CPT 33264: Implantable Defibrillator Pulse Generator Removal and Replacement

CPT-33267-LEFT-ATRIAL-APPENDAGE-EXCLUSION-OPEN-SURGERY

CPT 33267: Left Atrial Appendage Exclusion, Open Surgical Procedure

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Taxonomy Code	Specialty	Notes
`207RH0000X`	Thoracic Surgery	Surgeons who perform open and minimally invasive atrial surgical procedures.
`207L00000X`	Cardiovascular Surgery	Cardiac surgeons performing atrial fibrillation surgical ablation and reconstruction.
`207RP1001X`	Cardiac Electrophysiology	Electrophysiologists involved in hybrid procedures and intraoperative mapping.
`207R00000X`	Cardiac Surgery	General cardiac surgeons performing therapeutic atrial procedures.
`208D00000X`	Anesthesiology	Anesthesiologists providing general anesthesia for cardiac surgery.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I48.0`	Paroxysmal atrial fibrillation	Common indication for surgical ablation when symptomatic and refractory to medical therapy.
`I48.1`	Persistent atrial fibrillation	Typical indication for surgical lesion sets and atrial reconstruction.
`I48.2`	Chronic atrial fibrillation	Chronic AF often necessitates surgical intervention when other therapies fail.
`I48.91`	Unspecified atrial fibrillation	Used when documentation specifies atrial fibrillation without further subtyping.
`I50.9`	Heart failure, unspecified	Concurrent heart failure may influence surgical planning and postoperative management.
`I34.1`	Nonrheumatic mitral (valve) insufficiency	Valve disease may be present and addressed concurrently with atrial reconstruction.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Common comorbidity in patients undergoing cardiac surgery and relevant for perioperative risk assessment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33210`	Insertion of temporary single transvenous electrode, cardiac pacemaker, with connection to external pulse generator	May be performed preoperatively or intraoperatively for pacing support during or after atrial reconstruction.
`33208`	Insertion of epicardial ventricular pacing device (temporary), open approach	Used when temporary epicardial pacing wires are placed during surgical ablation for postoperative rhythm management.
`33249`	Insertion, permanent pacemaker, dual lead, atrial and ventricular	Performed when permanent pacing is indicated after surgical intervention for atrial arrhythmia or conduction disease.
`33257`	Removal of permanent pacemaker pulse generator with replacement (subsequent procedure)	Relevant if device revision or replacement is required in the perioperative period.
`93656`	Comprehensive electrophysiologic evaluation including transseptal catheterization when performed and insertion and repositioning of catheters when performed; with ablation of supraventricular tachycardia, complex	May be performed in hybrid cases where catheter-based mapping/ablation is combined with surgical ablation.

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