Summary & Overview
CPT 33268: Left Atrial Appendage Exclusion, Open Cardiac Surgery
CPT code 33268 denotes exclusion (for example, excision) of the left atrial appendage performed during the same surgical session as a primary procedure that requires sternotomy or thoracotomy. This code captures an adjunctive cardiac surgical step commonly performed during open-heart operations to address the left atrial appendage, a small pouch in the upper left chamber of the heart associated with thromboembolic risk. Nationally, accurate reporting of this code matters for clinical documentation, surgical quality reporting, and payment clarity for concurrent cardiac procedures.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for 33268, typical sites of service, and the service type. The publication provides benchmarks and policy-oriented context where available, highlights common billing modifiers listed in the input, and outlines implications for coding and claims workflows. Where input data is missing, the text notes the absence rather than inferring details. The material is intended for coding professionals, surgical billing teams, and policy analysts seeking a national perspective on how this adjunctive cardiac procedure is represented in administrative coding.
Billing Code Overview
CPT code 33268 describes exclusion, such as by excision, of the left atrial appendage performed at the same session as a primary procedure that requires a sternotomy or thoracotomy. The service involves removing or occluding the small, pouchlike sac in the top left chamber of the heart to reduce risk related to the appendage during open thoracic cardiac surgery.
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Service type: Surgical cardiac procedure (left atrial appendage exclusion performed concurrently with another open cardiac procedure)
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Typical site of service: Inpatient operating room or cardiac surgical suite during a procedure requiring sternotomy or thoracotomy
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 72-year-old man with persistent atrial fibrillation and left ventricular dysfunction is scheduled for surgical coronary artery bypass grafting (CABG) via median sternotomy. During the same operative session, the cardiothoracic surgeon performs exclusion of the left atrial appendage to reduce future thromboembolic risk. The intraoperative workflow includes general endotracheal anesthesia, median sternotomy, cardiopulmonary bypass as indicated, myocardial revascularization, inspection of the left atrial appendage, and surgical exclusion by excision or oversewing. Hemostasis is confirmed, chest tubes placed, and the sternum closed. Postoperative documentation includes indication for left atrial appendage exclusion, method used (excision, suture, or device), confirmation that the work was performed at the same session as the primary sternotomy procedure, estimated blood loss, complications, and any additional procedures or modifiers applied for billing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | When two surgeons work together as primary surgeons performing distinct parts of the operation on the same patient. |
63 | Procedure performed on infants less than 4 kg |