Wiki Hemiarch Penninsula Graft Help, report with 33870?


Santa Clara, CA
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All the resources I find from STS and others state hemiarch is included in all ascending aortic graft codes (codes 33860 – 33864). (

I have a provider doing a aortic ascending graft and a hemiarch transverse graft peninsula with hypothermic circulatory arrest. He is stating he should be able to report CPT 33870 for this hemiarch peninsula graft, stating he saw a resource somewhere stating the work is essentially the same as being displayed in cpt 33870 if the heimi arch is extensive and undercuts all the head vessels,
(Picture at this website -

A peninsula graft is an incision/graft from the greater curvature of the aorta proximal to the innominate artery to the lesser curvature of the arch to the level of the subclavian (in my case).

Any advice would be greatly appreciated, thank you so much for your time.
NOT POSTIVE on my response but my thought process is this: If he is undergrafting the aorta and not placing grafts on the head vessels than we are not suppose to bill the Hemiarch graft. The 33870 is mainly for the work of placing a graft on the head vessels. If the aortic graft is just extending into the hemiarch but cut to the shape of a "peninsula" shape to repair the extension of the arch I would think this work is not enough to warrant the extra coding. But if I had to explain this to to my physician I would state:: we are only suppose to bill 33870 if the graft was with the "head vessels" not if it "extending" into the hemi arch. The under graft of the hemi arch is inclusive and should not be billed.

"Code 33870 is bundled into all of the ascending aorta graft procedures (33860 – 33864). For procedures that involve reimplantation of the head vessels—either as an island pedicle or individually—the -59 modifier should be appended to code 33870 to pull it out of the bundle. The edit is to ensure that 33870 is not reported for situations where a hemi-arch repair is done and the head vessels are not involved in the procedure."

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