Summary & Overview
CPT 33267: Left Atrial Appendage Exclusion, Open Surgical Procedure
CPT code 33267 documents an open surgical exclusion (for example, excision) of the left atrial appendage, a pouch in the left atrium associated with thromboembolic risk. The code captures a definitive, invasive cardiac surgical intervention intended to remove or exclude the appendage, most commonly performed in the operating room during cardiac surgery. Nationally, this code matters for surgical billing, hospital resource use, and management of stroke risk in patients with cardiac conditions that predispose to clot formation.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides readers with reimbursement and utilization benchmarks where available, payer coverage considerations, clinical context for when open exclusion is used versus less invasive options, and relevant coding guidance. Content highlights the clinical setting, typical site-of-service implications for hospital billing, and common modifiers used with the procedure (modifier details provided elsewhere).
Readers will learn: the clinical intent and procedural setting for CPT code 33267, how major national payers approach coverage and payment (Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, Medicare), and the types of benchmarks and policy updates that influence coding and billing for open left atrial appendage exclusion. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 33267 describes the open surgical exclusion, such as by excision, of the left atrial appendage, a small pouchlike sac in the top left chamber of the heart. This procedure removes or obliterates the appendage to reduce thromboembolic risk associated with conditions that predispose to clot formation.
Service type: Open cardiac surgical procedure
Typical site of service: Inpatient operating room / cardiac surgery suite
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with persistent nonvalvular atrial fibrillation and a history of prior intracranial hemorrhage is scheduled for an open surgical left atrial appendage exclusion. The patient has contraindications to long-term oral anticoagulation. Preoperative evaluation includes cardiology consultation, transthoracic and transesophageal echocardiography to assess left atrial appendage anatomy and rule out thrombus, routine pre-op labs, and anesthesia assessment. The procedure is performed in an operating room under general endotracheal anesthesia. The cardiothoracic surgeon performs a median sternotomy or thoracotomy as indicated, exposes the heart, and excises or surgically excludes the left atrial appendage (left atrial appendage excision) with direct closure or oversewing of the appendage base. Intraoperative transesophageal echocardiography may confirm complete exclusion. Postoperative care includes ICU monitoring for hemodynamics, arrhythmia surveillance, pain control, wound care, and decisions about resuming antithrombotic therapy. Discharge planning includes follow-up with cardiology and cardiothoracic surgery and documentation of the exclusion technique and pathology if applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when additional work or complexity beyond the typical service occurred (document specifics). |