Ask Dr. Z

My cardiac surgeon places an antegrade elephant trunk descending thoracic endograft by deploying the graft via an open aortic incision during a concurrent open ascending/arch replacement. Approach is sternotomy with transection of the ascending aorta. The vascular co-surgeon then gains access via femoral artery and threads a guidewire up to the area of transection, where it is exteriorized. The elephant trunk endograft is deployed antegrade by direct visualization, followed by completion of the ascending/arch graft replacement. There is confusion over whether the descending thoracic graft should be billed with 33880/33881 because it is an endograft (regardless of approach or direction of deployment) or if it should be billed with 33875 because it is an open approach for graft placement. Can you advise?