Summary & Overview
CPT 33858: Aortic Dissection Repair with Graft and Cardiopulmonary Bypass
CPT code 33858 designates open surgical repair of an aortic dissection with graft placement, performed with initiation of cardiopulmonary bypass and possible suspension of the aortic valve within the graft. This procedure is a high-acuity, resource-intensive cardiothoracic operation with implications for operative planning, facility capability, and national payment policy for complex vascular surgery. It is relevant to hospital payment systems, inpatient surgical quality measures, and risk adjustment for postoperative care. Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for the service, the typical inpatient operating-room setting, and the procedural elements that drive resource use. The publication outlines what to expect in terms of service classification, common modifiers and coding considerations (where available), and the relationship of the code to broader cardiovascular surgical care. Benchmarks and payer policy summaries are provided where data exist. Data not available in the input is noted when applicable. This summary is intended for coding professionals, hospital billing analysts, and policy stakeholders seeking a concise national overview of CPT code 33858.
Billing Code Overview
CPT code 33858 describes surgical repair of an aortic dissection with insertion of a graft. The procedure includes initiation of cardiopulmonary bypass to divert blood flow around the heart and lungs during the repair. The surgeon may suspend the aortic valve to a desired height within the grafted vessel as part of the reconstruction.
Service Type: Open thoracic aortic surgery with cardiopulmonary bypass
Typical Site of Service: Inpatient operating room for major cardiovascular surgery, commonly performed in tertiary or quaternary care hospitals with cardiothoracic surgery capability.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male presents emergently with acute severe chest and back pain and hemodynamic instability. Imaging with CT angiography confirms an acute Stanford type A aortic dissection involving the ascending aorta with extension into the aortic arch. The cardiothoracic surgery team proceeds to the operating room for open repair. The provider initiates cardiopulmonary bypass, explants the diseased ascending aorta segment, and replaces it with a synthetic tubular graft. During the operation the surgeon suspends the native aortic valve within the graft to restore valve height and competence. Intraoperative transesophageal echocardiography guides repair and confirms valve function before weaning from bypass. Typical workflow includes preoperative stabilization in the emergency department or ICU, emergent operative consent, anesthesia induction, median sternotomy, institution of cardiopulmonary bypass, aortic graft replacement with or without valve-suspension, protamine reversal, chest closure, and postoperative transfer to the cardiovascular ICU for hemodynamic monitoring and ventilatory support. Typical site of service is an inpatient acute care hospital operating room with postoperative care in the cardiovascular intensive care unit.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Routine reporting when no additional modifier applies |