Summary & Overview
CPT 33519: Coronary Artery Bypass with Three Venous Grafts
CPT code 33519 denotes a coronary artery bypass grafting procedure involving three venous grafts performed as part of a combined venous and arterial revascularization. This code captures a complex open-heart surgical intervention aimed at restoring coronary circulation, improving cardiac function, and reducing symptoms such as angina. Nationally, CABG procedures remain a critical component of surgical management for multivessel coronary artery disease and carry significant implications for hospital resource use, episode cost, and quality measurement.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for 33519, typical sites of service, common modifiers and how they relate to billing complexity, and the payer mix typically relevant for cardiac surgical episodes. The publication also outlines benchmarks commonly used to assess utilization and payment for CABG procedures, highlights policy or coding clarifications when applicable, and provides guidance on documentation themes that support accurate coding. Data not available in the input is noted where applicable. The content is intended to inform coding, billing, and policy stakeholders nationally about the clinical and administrative profile of CPT code 33519 without offering clinical recommendations.
Billing Code Overview
CPT code 33519 describes a coronary artery bypass graft (CABG) procedure in which the surgeon grafts three vein segments, typically harvested from another site such as the leg, to bypass damaged coronary vessels while the patient undergoes a combined venous and arterial grafting operation. The procedure is performed to restore myocardial blood flow, improve cardiac function, and reduce ischemic symptoms such as angina.
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Service type: Surgical revascularization (coronary artery bypass grafting with three venous grafts as part of combined venous and arterial grafting)
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Typical site of service: Inpatient hospital operating room or cardiac surgery suite during an admitted surgical episode
Clinical & Coding Specifications
Clinical Context
A 67-year-old male with multivessel coronary artery disease presents with progressive exertional angina and decreased exercise tolerance despite optimal medical therapy. Coronary angiography demonstrates high-grade stenoses in the right coronary artery, obtuse marginal branch, and a diagonal branch of the left anterior descending artery, along with an additional lesion best treated with an arterial graft. The cardiothoracic surgeon schedules a coronary artery bypass grafting (CABG) procedure that includes both arterial and venous conduits. Intraoperatively the surgeon harvests three separate vein segments (typically saphenous vein from the leg) and performs three venous bypass grafts in addition to arterial grafting.
The typical clinical workflow includes preoperative evaluation (history, physical, ECG, labs, cardiac catheterization), preoperative anesthesia assessment, operative scheduling in a hospital operating room or cardiac surgery suite, general endotracheal anesthesia, median sternotomy, cardiopulmonary bypass with cardioplegic arrest as indicated, harvesting of saphenous vein segments, creation of three venous distal anastomoses and proximal graft anastomoses to the aorta, completion of any arterial grafting (eg, internal mammary artery), weaning from bypass, hemostasis and chest closure, and postoperative care in the intensive care unit with telemetry monitoring. Typical site of service is an inpatient hospital operating room. The service type is surgical — open coronary artery bypass grafting with combined venous and arterial grafting including three venous grafts (33519).
Coding Specifications
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