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CPT®
33870

CPT® Code 33870
Deleted

Code deleted, see 33871

Official Description

Transverse arch graft, with cardiopulmonary bypass

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 33870 involves the surgical repair of a transverse arch aortic aneurysm using a graft, while the patient is placed on cardiopulmonary bypass. A transverse arch aortic aneurysm refers to a dilation or bulging in the aorta, specifically in the section that curves over the heart. This condition can lead to serious complications, including rupture or dissection, necessitating surgical intervention. During the procedure, access to the heart is achieved through a median sternotomy, which involves making an incision along the sternum to open the chest cavity. The right subclavian and right femoral arteries are cannulated to facilitate the establishment of cardiopulmonary bypass, allowing for the heart and lungs to be temporarily taken over by a machine that oxygenates the blood and circulates it throughout the body. This is crucial for maintaining blood flow and oxygen delivery while the surgical team repairs the aorta. The procedure includes the mobilization of the aortic arch and its branches, transection of the aorta, and replacement of the diseased section with a graft. Depending on the technique used, either an en bloc or separated graft method is employed to reconstruct the aortic arch and its branches, ensuring proper blood flow to the brain and upper body. The complexity of this procedure underscores the need for meticulous surgical technique and careful postoperative management to ensure patient safety and recovery.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 33870 is indicated for the surgical repair of a transverse arch aortic aneurysm. This condition may present with various symptoms or complications that necessitate intervention, including:

  • Aortic Aneurysm: A dilation or bulging in the aorta that poses a risk of rupture or dissection.
  • Chest Pain: Patients may experience severe chest pain due to the stress on the aortic wall.
  • Shortness of Breath: This may occur if the aneurysm affects blood flow or if there is associated heart failure.
  • Neurological Symptoms: Symptoms such as dizziness or fainting may arise if cerebral perfusion is compromised.

2. Procedure

The surgical procedure for CPT® Code 33870 involves several critical steps to ensure the successful repair of the transverse arch aortic aneurysm:

  • Step 1: The patient is placed under general anesthesia, and a median sternotomy is performed to access the heart. This involves making a vertical incision along the sternum to open the chest cavity.
  • Step 2: Cannulation of the right subclavian and right femoral arteries is performed to establish cardiopulmonary bypass. This allows the heart-lung machine to take over the function of pumping blood and oxygenating it during the procedure.
  • Step 3: Once cardiopulmonary bypass is established, retrograde cold blood cardioplegia is initiated to protect the heart during surgery. This involves infusing cold blood into the coronary arteries to induce cardiac arrest and reduce metabolic demand.
  • Step 4: The femoral cannula is clamped, and cerebral perfusion is initiated via the subclavian cannula. Alternatively, this may occur after the anastomosis of the left carotid artery, ensuring adequate blood flow to the brain.
  • Step 5: The aortic arch and its branches are mobilized, and the aorta is transected to remove the diseased section. This step is critical for preparing the site for graft placement.
  • Step 6: Depending on the technique chosen, either an en bloc or separated graft technique is employed. In the en bloc technique, a tube graft is placed, and the brachiocephalic, left common carotid, and left subclavian arteries are reconstructed and attached to the graft. In the separated graft technique, a prefabricated four-branched aortic arch prosthesis is utilized, with three branches corresponding to the major arteries and the fourth branch designated for cerebral perfusion.
  • Step 7: The branched aortic arch prosthesis is inserted, and the distal end is anastomosed to the aorta. The left common carotid artery is sutured to the prosthesis, followed by the administration of cerebral perfusion through the fourth branch and the right subclavian artery.
  • Step 8: The left subclavian and brachiocephalic arteries are sutured to the prosthesis, ensuring proper re-establishment of blood flow.
  • Step 9: The proximal end of the prosthesis is then anastomosed to the aorta, completing the graft placement.
  • Step 10: Cardiopulmonary bypass is terminated, and the fourth branch of the prosthesis is resected. Chest tubes are placed as needed to facilitate drainage, and the chest is closed.

3. Post-Procedure

After the completion of the procedure, patients are typically monitored in a recovery area or intensive care unit for close observation. Post-procedure care may include managing pain, monitoring vital signs, and ensuring proper drainage from chest tubes. Patients may require additional imaging studies to assess the success of the graft and the integrity of blood flow. The expected recovery period can vary based on individual patient factors and the complexity of the surgery, but careful follow-up is essential to monitor for any complications such as infection, graft failure, or neurological deficits. Rehabilitation and gradual return to normal activities will be guided by the healthcare team based on the patient's progress.
Short Descr TRANSVERSE AORTIC ARCH GRAFT
Medium Descr TRANSVERSE ARCH GRAFT W/CARDIOPULMONARY BYPASS
Long Descr Transverse arch graft, with cardiopulmonary bypass
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P2F - Major procedure, cardiovascular-Other
MUE Not applicable/unspecified.
CCS Clinical Classification 52 - Aortic resection, replacement or anastomosis
Date
Action
Notes
2019-12-31 Deleted Code deleted, see 33871
Pre-1990 Added Code added.
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