CPT® Code 33267

Exclusion of left atrial appendage, open, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip)

The procedure described by CPT® Code 33267 refers to the open exclusion of the left atrial appendage (LAA) using any method, which may include excision, isolation via stapling, oversewing, ligation, plication, or the application of a clip. This surgical intervention is primarily indicated for patients diagnosed with non-valvular atrial fibrillation (NVAF) who are at a heightened risk for thrombus formation or stroke, particularly when oral anticoagulation therapy is not a viable option. The LAA is a small, pouch-like structure located in the left atrium of the heart, and it can be a site for blood clots to form, which can lead to serious complications such as stroke. By performing an exclusion of the LAA, the procedure aims to completely close off or remove this anatomical structure, thereby preventing it from retaining blood and reducing the risk of clot development. The surgical approach can be either endocardial, which involves directly accessing the heart's interior to amputate the LAA, or epicardial, where closure methods are applied externally. The choice of technique may depend on various factors, including the unique anatomical variations of the LAA, which can be classified into four distinct morphological groups, as well as the patient's specific cardiac conditions and rhythm status. This code specifically applies when the LAA exclusion is the sole procedure conducted during the surgical encounter, distinguishing it from other related codes that may apply when performed alongside additional cardiac procedures.