CPT 33845 Aortic Stricture Repair Reimbursement | OpenPayer

Summary & Overview

CPT 33845: Excision of Aortic Stricture with Tissue Graft Repair

CPT code 33845 represents an open surgical procedure to excise an aortic stricture and reconstruct the aorta using a tissue graft; repair of a concurrent patent ductus arteriosus may be performed if present. This code captures a high-complexity cardiovascular operation that has implications for surgical resource use, hospital length of stay, and reimbursement for thoracic vascular services nationally. Payors evaluated in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise overview of the clinical context for CPT code 33845, typical sites of service, and how this procedure is categorized for billing purposes. The publication summarizes common payer coverage patterns, useful benchmarks for utilization and payment where available, and recent policy or coding guidance that affects billing and claims processing for complex aortic reconstructive surgery. The report also outlines operational considerations relevant to coding capture, documentation elements that support medical necessity, and related CPT codes and service-line implications. Data not available in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare33845CPTaortic surgeryvascular surgerycardiothoracicsurgical repairtissue graftinpatient surgery

Billing Code Overview

CPT code 33845 describes a surgical procedure in which the provider excises an aortic stricture causing narrowing of the aorta and performs repair using a tissue graft. The description notes the surgeon may also repair a patent ductus arteriosus if present.

Service type: Open surgical aortic repair with excision of stricture and tissue graft reconstruction
Typical site of service: Inpatient operating room or specialized cardiovascular surgical suite in a hospital setting

Clinical & Coding Specifications

Clinical Context

A 12-year-old patient presents with progressive exertional dyspnea, weak femoral pulses, and differential blood pressures between the upper and lower extremities. Imaging with echocardiography and CT angiography confirms a discrete post-ductal coarctation (aortic stricture) distal to the left subclavian artery; a small patent ductus arteriosus is also identified. The cardiovascular surgical team schedules an open surgical repair. In the operating room under general anesthesia, the surgeon excises the aortic stricture and reconstructs the aortic continuity using a tissue graft (patch or interposition graft). If a patent ductus arteriosus is present, it is repaired during the same operation. Perioperative workflow includes preoperative cardiology evaluation, anesthetic induction with arterial and central venous monitoring, intraoperative transesophageal echocardiography as indicated, postoperative ICU monitoring for hemodynamics and bleeding, and follow-up imaging to confirm repair patency.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier—standard reporting	Use when no specific modifier applies to the service.
`11`	Office or other outpatient service as defined by payer

CPT 33822: Pediatric Ductus Division and Major Vessel Repair

CPT-33852-AORTIC-ARCH-REPAIR-NO-CPB

CPT 33852: Aortic Arch Repair Without Cardiopulmonary Bypass

CPT-33820-DUCTUS-OR-MAJOR-VESSEL-LIGATION-AND-CLOSURE

CPT 33820: Ligation and Closure of Ductus or Major Cardiac Vessel

CPT-33840-AORTIC-STRICTURE-EXCISION-PRIMARY-ANASTOMOSIS

CPT 33840: Excision of Aortic Stricture with Primary Anastomosis

CPT-33814-AORTOPULMONARY-DEFECT-REPAIR-CARDIOPULMONARY-BYPASS

CPT 33814: Aortopulmonary Defect Repair with Cardiopulmonary Bypass

CPT-33802-ABERRANT-VESSEL-REPAIR

CPT 33802: Surgical Repair of Aberrant Vessel

CPT-33824-ADULT-DUCTUS-OR-INTERARTERIAL-OPENING-REPAIR

CPT 33824: Repair of Major Vessels Ductus or Interarterial Opening

CPT-33853-AORTIC-ARCH-REPAIR-WITH-BYPASS

CPT 33853: Aortic Arch Repair With Graft and Cardiopulmonary Bypass

CPT-33803-REPAIR-ABERRANT-ARTERY-REANASTOMOSIS

CPT 33803: Repair of Aberrant Artery with Reanastomosis

CPT-33851-AORTIC-NARROWING-EXCISION-PDA-REPAIR

CPT 33851: Excision of Aortic Narrowing, ± PDA Repair

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Taxonomy Code	Specialty	Notes
207K00000X	Pediatric Cardiothoracic Surgery	Surgeons specializing in congenital and pediatric aortic repairs.
207L00000X	Thoracic Surgery	Adult thoracic surgeons performing open aortic reconstructions.
2080P0004X	Cardiovascular Surgery	Cardiovascular surgeons who perform aortic coarctation excision and graft repair.
207RC0000X	Pediatric Cardiology	Preoperative and postoperative cardiac management and imaging.
207L00000X-SUPP	Cardiac Anesthesiology	Anesthesiologists specializing in cardiac/thoracic procedures (monitoring and complex anesthesia).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I71.1`	Thoracic aortic aneurysm, unspecified site	May coexist with or complicate aortic pathology requiring resection and grafting.
`I74.3`	Arterial embolism and thrombosis of lower extremity	Not typical primary diagnosis but thromboembolic complications can arise in aortic disease contexts.
`Q25.1`	Coarctation of aorta	Primary diagnosis indicating congenital aortic narrowing treated by excision and graft repair.
`Q25.0`	Patent ductus arteriosus	Frequently assessed and repaired when present concomitantly with coarctation.
`I71.3`	Thoracoabdominal aortic aneurysm, ruptured	Emergent aortic pathology that may require complex resection and grafting; included for surgical relevance.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33405`	Repair of patent ductus arteriosus; simple ligation or division	May be performed concurrently if a PDA requires direct repair instead of or in addition to aortic reconstruction.
`93503`	Insertion and placement of flow-directed catheter (Swan-Ganz) for monitoring, when performed	Invasive hemodynamic monitoring may be placed perioperatively for complex cardiovascular cases.
`93312`	Echocardiography, transesophageal, real-time with image documentation (intraoperative)	Intraoperative TEE may be used to assess anatomy and immediate repair results.
`99291`	Critical care, evaluation and management of the critically ill patient, first 30-74 minutes	Postoperative ICU management for high-acuity patients after major aortic surgery.
`35820`	Arterial repair; with or without patch graft, non-coronary, with vascular anastomosis	Related vascular reconstruction concepts; used for other arterial patch or graft repairs in the operative setting.

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