Summary & Overview
CPT 33518: Two-Vessel Coronary Artery Bypass with Two Vein Grafts
CPT code 33518 identifies a coronary artery bypass grafting (CABG) operation involving two vein grafts harvested from another body site, performed in conjunction with arterial grafting. This procedure restores coronary blood flow, improves cardiac function, and relieves ischemic symptoms such as angina. Nationally, CABG procedures remain a critical component of advanced cardiac surgical care and are closely monitored for quality, outcomes, and appropriate utilization.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and billing-focused overview of the procedure, typical sites of service, commonly reported modifiers, and context for coding and claims submission. The publication summarizes payer coverage patterns and standard billing practices where available and highlights the clinical circumstances that typically prompt use of this CPT code.
The report provides benchmarks and policy-relevant context so clinicians, coders, and administrators can understand how CPT code 33518 is used in practice, what to expect on the service line, and where to look for payer-specific guidance. Data not available in the input is clearly noted where applicable.
Billing Code Overview
CPT code 33518 describes a surgical coronary artery bypass grafting (CABG) procedure in which the surgeon grafts two vein segments, typically harvested from another site such as the leg, to bypass damaged coronary vessels. The procedure is performed to restore myocardial blood flow, improve cardiac function, and reduce symptoms such as angina.
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Service type: Surgical coronary artery bypass grafting with two venous grafts and arterial grafting component
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Typical site of service: Inpatient hospital operating room; performed during an open cardiac surgery admission under general anesthesia
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with multivessel coronary artery disease and progressive exertional angina is scheduled for coronary artery bypass grafting with both arterial and venous conduits. Preoperative coronary angiography demonstrates significant left anterior descending and right coronary artery stenoses and occlusive disease of a circumflex branch. The cardiothoracic surgeon harvests the left internal mammary artery for an arterial graft and obtains two saphenous vein segments from the leg to create two venous bypass grafts during the same operative session. The operative goal is to divert blood flow around damaged native coronary vessels, restore myocardial perfusion, improve left ventricular function, and reduce ischemic symptoms.
The typical clinical workflow includes preoperative evaluation (history, cardiac catheterization, echocardiography, anesthesia assessment), intraoperative median sternotomy and cardiopulmonary bypass, conduit harvest (saphenous vein segments), construction of two venous graft anastomoses in addition to any arterial grafting, hemostasis and chest closure, and postoperative transfer to the cardiac ICU for monitoring, pain control, and early mobilization. Documentation should support laterality of vein harvest, number of grafts (venous and arterial), use of cardiopulmonary bypass if applicable, operative findings, and any intraoperative complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of the CABG procedure. |