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The procedure described by CPT® Code 33476 involves a surgical intervention known as right ventricular resection, specifically targeting infundibular pulmonary stenosis. This condition is characterized by an obstruction that occurs at the outflow tract of the right ventricle, which can significantly impede blood flow from the heart to the lungs. The obstruction may arise from a fibrous muscle band located at the junction where the main cavity of the right ventricle meets the infundibulum, effectively dividing the right ventricle into two distinct cavities. Alternatively, the obstruction can be caused by a hypertrophied infundibulum, which is a thickening of the muscular wall that narrows the outlet of the right ventricle. To perform this procedure, the surgeon typically begins by exposing the heart through a median sternotomy, which involves making an incision along the sternum to gain access to the thoracic cavity. Once the heart is accessible, cardiopulmonary bypass is established to take over the function of the heart and lungs during the surgery, allowing for a bloodless field and enabling the surgeon to operate safely. The right ventricle is then incised to access the area of obstruction. The surgical approach may involve excising the obstructive fibrous muscle band to alleviate the blockage or removing tissue from the thickened muscular infundibulum to enlarge the outflow tract, thereby improving blood flow. Additionally, the pulmonary valve is carefully inspected during the procedure. If the commissures of the valve are found to be fused, the surgeon will perform a commissurotomy, which involves using sharp dissection to open the three commissures of the valve. This step is crucial for ensuring proper function of the valve post-surgery. After the necessary corrections are made, the heart is closed, and the patient is gradually weaned off cardiopulmonary bypass. Finally, chest tubes may be placed as needed to facilitate drainage, and the chest is closed to complete the procedure.
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The procedure described by CPT® Code 33476 is indicated for patients presenting with infundibular pulmonary stenosis, which is characterized by the following conditions:
The surgical procedure for CPT® Code 33476 involves several critical steps to effectively address the obstruction in the right ventricle:
Post-procedure care following a right ventricular resection for infundibular stenosis includes monitoring the patient for any complications related to the surgery. Patients are typically observed in a recovery area where vital signs are closely monitored. The presence of chest tubes allows for the drainage of any excess fluid, which is essential for preventing complications such as pleural effusion. The expected recovery period may vary depending on the individual patient's condition and the extent of the surgery performed. Patients may require pain management and supportive care as they begin to regain strength. Follow-up appointments are crucial to assess the surgical outcome and ensure that the heart is functioning properly after the intervention.
| Short Descr | REVISION OF HEART CHAMBER | Medium Descr | R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY | Long Descr | Right ventricular resection for infundibular stenosis, with or without commissurotomy | 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) | 33924 | Addon Code MPFS Status: Active Code APC C CPT Assistant Article Ligation and takedown of a systemic-to-pulmonary artery shunt, performed in conjunction with a congenital heart procedure (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) |
| 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). | 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 |
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| Pre-1990 | Added | Code added. |
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