Summary & Overview
CPT 33915: Pulmonary Embolectomy for Acute Pulmonary Embolism
CPT code 33915 represents an urgent surgical pulmonary embolectomy to remove an embolus or blockage from the pulmonary artery. This is a high-acuity, potentially life-saving cardiothoracic procedure performed when a thrombus obstructs pulmonary blood flow. The code explicitly excludes cardiopulmonary bypass and denotes an operative intervention for acute pulmonary embolism.
Key national payers relevant to coverage and reimbursement for this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Payer policy and authorization pathways for emergent surgical management can influence access, site of service decisions, and coding applicability.
Readers will find a concise clinical and billing overview of the procedure, descriptions of typical settings where the service is delivered, and the payer landscape covered in this analysis. The publication provides benchmarks and policy context relevant to emergent cardiothoracic surgical coding, guidance on documentation elements tied to this CPT code, and pointers to subordinate topics such as modifier use and related diagnosis coding. Data not available in the input will be identified as such in the detailed sections.
This summary is written for a national audience seeking clarity on clinical intent, coding boundaries, and the payer environment for surgical treatment of acute pulmonary embolism using CPT code 33915.
Billing Code Overview
CPT code 33915 describes an urgent surgical procedure to remove an embolus or blockage from the pulmonary artery. The procedure addresses a life-threatening pulmonary embolism caused by a traveling blood clot that obstructs blood flow to the lungs. This code specifically denotes surgical embolectomy of the pulmonary artery and does not include cardiopulmonary bypass.
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Service type: Emergent surgical vascular procedure (pulmonary embolectomy)
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Typical site of service: Hospital operating room or hybrid surgical suite for emergency cardiothoracic or vascular surgery
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents to the emergency department with sudden-onset shortness of breath, pleuritic chest pain, tachycardia, hypoxia, and hypotension. Imaging with CT pulmonary angiography demonstrates a large saddle pulmonary embolus obstructing the main pulmonary artery and right or left pulmonary branches. The patient is hemodynamically unstable and either has contraindications to systemic thrombolysis or has failed thrombolytic therapy. Cardiology, cardiothoracic surgery, and interventional radiology are consulted and determine an urgent surgical pulmonary embolectomy without cardiopulmonary bypass is indicated.
The clinical workflow includes emergency stabilization (airway, oxygenation, IV access, hemodynamic support), diagnostic imaging and laboratory evaluation, informed consent for urgent surgery, preoperative clearance as feasible, transport to the operating room, general anesthesia, surgical exposure of the pulmonary artery via median sternotomy or thoracotomy, embolectomy performed to remove obstructing thrombus, intraoperative assessment of pulmonary perfusion, hemostasis and closure, and immediate postoperative monitoring in an intensive care unit with anticoagulation initiation when appropriate. Payors involved commonly include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for 33915 and documentation supports increased work or complexity. |
23 | Unusual anesthesia | Use when general anesthesia is not administered for an otherwise normally non-anesthetized procedure; rarely applicable but included if anesthesia circumstances differ. |
26 | Professional component | Use if billing separates professional services from technical; uncommon for 33915 which is typically global. |
50 | Bilateral procedure | Use if embolectomy is performed bilaterally and payer requires bilateral modifier; document bilateral involvement. |
51 | Multiple procedures | Use when 33915 is billed with other distinct surgical procedures during the same operative session. |
52 | Reduced services | Use when the procedure is partially reduced or aborted but still performed to a limited extent. |
53 | Discontinued procedure | Use when the procedure is started but discontinued for documented extenuating circumstances. |
62 | Two surgeons | Use when two surgeons from different specialties share equal responsibility for performance of 33915. |
78 | Unplanned return to OR | Use for a return to the operating room for related procedure during the postoperative period. |
79 | Unrelated procedure by same physician during global period | (Not in provided list) Data not available in the input. |
AS | Ambulatory surgery center facility fee | Use when the service is performed in an ambulatory surgery center setting; typically not applicable for emergent 33915. |
ET | Educational/training for residents | Use when teaching physician documents involvement per payer rules (use of QK/QX/QY frequently applies for assistant at surgery scenarios). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
208100000X | Thoracic Surgery | Primary specialty performing pulmonary embolectomy in many centers. |
208000000X | Cardiothoracic Surgery | Frequently performs surgical pulmonary embolectomy; experienced with central pulmonary artery exposure. |
207RP1001X | Interventional Cardiology | May be involved in hybrid cases or catheter-based thrombectomy adjuncts. |
208600000X | Vascular Surgery | May participate when thromboembolic disease is extensive or combined vascular procedures are needed. |
207Q00000X | Critical Care Medicine | Provides perioperative critical care management; not the operating surgeon but integral to care. |
Note: Modifier selection must be supported by operative and anesthesia documentation. The list of modifiers above is a clinically focused subset drawn from the provided modifier set.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I26.0 | Pulmonary embolism with acute cor pulmonale | Represents large, life-threatening pulmonary embolus that may require urgent surgical embolectomy such as 33915. |
I26.9 | Pulmonary embolism without acute cor pulmonale | Common diagnosis for pulmonary embolism; may progress to hemodynamic instability prompting embolectomy. |
I82.40 | Acute embolism and thrombosis of unspecified deep veins of lower extremity | Source thrombus for pulmonary embolism; documents deep venous thrombosis as etiology. |
I82.401 | Acute embolism and thrombosis of right deep veins of lower extremity | Side-specific DVT codes often accompany PE diagnosis and procedures. |
I82.402 | Acute embolism and thrombosis of left deep veins of lower extremity | Side-specific DVT codes often accompany PE diagnosis and procedures. |
R57.0 | Cardiogenic shock | Used when hemodynamic collapse accompanies massive PE, often present in patients undergoing emergent embolectomy. |
I80.2 | Phlebitis and thrombosis of other deep vessels of lower extremities | Indicates venous thrombosis contributing to embolic event. |
These diagnosis codes reflect typical clinical scenarios prompting urgent surgical pulmonary embolectomy; selection must match documented clinical findings and laterality where applicable.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
00560 | Anesthesia for procedures on heart and pericardial structures, esophagus and diaphragm (e.g., for thoracic procedures) | Anesthesia codes like 00560 are used to report general anesthesia services for surgical pulmonary embolectomy when anesthesia is provided. |
32551 | Tube thoracostomy, includes waterseal (eg, for postoperative chest drainage) | May be performed intraoperatively or postoperatively for pleural drainage after thoracotomy or sternotomy associated with 33915. |
33361 | Right heart cardiac catheterization (selective pulmonary artery) | Diagnostic or therapeutic catheterization may be performed pre- or postoperatively for pulmonary artery assessment or catheter-directed therapy in hybrid management. |
37184 | Placement of thrombectomy catheter, percutaneous, including mechanical thrombectomy (peripheral) | Endovascular thrombectomy codes may be used when combined catheter-based thrombectomy strategies are attempted before or after surgical embolectomy. |
99100 | Anesthesia time or critical care surge (example supplemental code) | Used for reporting unusual anesthesia or critical care time associated with prolonged emergent 33915 cases when payers allow. |
99291 | Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes | Used for preoperative or postoperative critical care provided to hemodynamically unstable patients undergoing surgical pulmonary embolectomy. |
If additional facility or payer-specific codes are required, billing should follow individual payer policies of Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.