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The procedure described by CPT® Code 33414 involves the surgical repair of a left ventricular outflow tract obstruction (LVOTO) through a technique known as patch enlargement. This condition specifically pertains to obstructions that occur in the subvalvular region of the heart, meaning that the obstruction is located below the aortic valve and does not involve the aortic valve itself or the junction between the left ventricle and the aorta. The obstruction can lead to significant complications, as it hinders the normal flow of blood from the left ventricle, resulting in increased pressure and workload on the heart. Over time, this increased workload can cause the heart muscle to thicken, a condition known as left ventricular hypertrophy, and may ultimately lead to heart failure if not addressed. To perform this procedure, the surgeon gains access to the heart through a median sternotomy, which involves making an incision along the sternum to open the chest cavity. Once access is achieved, cardiopulmonary bypass is initiated to take over the function of the heart and lungs during the surgery, allowing the surgeon to operate on a still and bloodless field. The surgical approach involves making an incision in the right ventricle to access the ventricular septum, which is the wall separating the left and right ventricles. The surgeon then incises the ventricular septum and utilizes a synthetic patch to enlarge the outflow tract of the left ventricle, effectively alleviating the obstruction. After the patch is placed, the incision in the right ventricle is closed using a pericardial patch, and once the procedure is complete, cardiopulmonary bypass is discontinued, and the chest incisions are closed. This comprehensive approach aims to restore normal blood flow from the left ventricle, thereby reducing the risk of further cardiac complications.
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The procedure described by CPT® Code 33414 is indicated for patients experiencing left ventricular outflow tract obstruction (LVOTO) that is specifically related to subvalvular tissue. The following conditions may warrant this surgical intervention:
The surgical procedure for CPT® Code 33414 involves several critical steps to effectively repair the left ventricular outflow tract obstruction:
After the completion of the procedure, patients typically require close monitoring in a postoperative setting to assess their recovery. The expected recovery period may involve observation for any complications related to the surgery, such as bleeding or infection. Patients may also need to undergo cardiac rehabilitation to support their recovery and improve heart function. Follow-up appointments will be necessary to evaluate the success of the procedure and to monitor for any recurrence of obstruction or other cardiac issues. The overall goal of post-procedure care is to ensure that the patient can return to normal activities while minimizing the risk of further cardiac complications.
| Short Descr | REPAIR OF AORTIC VALVE | Medium Descr | RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC | Long Descr | Repair of left ventricular outflow tract obstruction by patch enlargement of the outflow tract | 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 | 1 | CCS Clinical Classification | 43 - Heart valve procedures |
This is a primary code that can be used with these additional add-on codes.
| 33141 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting PUB 100 CPT Assistant Article Transmyocardial laser revascularization, by thoracotomy; performed at the time of other open cardiac procedure(s) (List separately in addition to code for primary procedure) | 33257 | Addon Code MPFS Status: Active Code APC C Illustration for Code Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), limited (eg, modified maze procedure) (List separately in addition to code for primary procedure) | 33259 | Addon Code MPFS Status: Active Code APC C Illustration for Code Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (eg, maze procedure), with cardiopulmonary bypass (List separately in addition to code for primary procedure) | 33530 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Reoperation, coronary artery bypass procedure or valve procedure, more than 1 month after original operation (List separately in addition to code for primary procedure) | 34714 | Addon Code MPFS Status: Active Code APC N ASC N1 Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition to code for primary procedure) | 34716 | Addon Code MPFS Status: Active Code APC N ASC N1 Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure) | 34833 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open iliac artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by abdominal or retroperitoneal incision, unilateral (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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