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The procedure described by CPT® Code 33505 involves the surgical repair of an anomalous coronary artery that originates from the pulmonary artery. This condition can lead to significant cardiac complications, as the anomalous artery may not supply adequate blood flow to the heart muscle. The surgical intervention, known as the Takeuchi procedure, aims to correct this anomaly by constructing an intrapulmonary artery tunnel. During the operation, the physician gains access to the heart through a median sternotomy, which involves making an incision along the sternum to open the chest cavity. The procedure can be performed using cardiopulmonary bypass, which temporarily takes over the function of the heart and lungs, or it can be done on a beating heart using an off-pump technique, allowing for a more direct approach without the need for bypass. The pericardium, the protective sac surrounding the heart, is incised, and a section is harvested to create the tunnel necessary for the repair. An aortopulmonary window is then created in the walls of both the aorta and the pulmonary artery, facilitating the construction of the tunnel. This tunnel is fashioned from the harvested pericardial tissue and is attached to the origin of the anomalous coronary artery within the pulmonary artery. It is then passed through the pulmonary artery to the aortopulmonary window and secured to the aorta, effectively rerouting blood flow. After the completion of the procedure, if cardiopulmonary bypass was utilized, it is discontinued, and chest tubes may be placed as needed before closing the chest. This complex surgical intervention is critical for restoring normal coronary circulation and preventing potential cardiac complications associated with the anomalous artery.
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The Takeuchi procedure, represented by CPT® Code 33505, is indicated for patients with an anomalous coronary artery that originates from the pulmonary artery. This condition can lead to various symptoms and complications, necessitating surgical intervention to restore normal coronary blood flow. The following are specific indications for performing this procedure:
The Takeuchi procedure involves several critical steps to repair the anomalous coronary artery. Each step is essential for ensuring the success of the surgery and the restoration of normal blood flow to the heart.
After the completion of the Takeuchi procedure, patients typically require close monitoring in a postoperative setting. The expected recovery involves managing pain, monitoring for any complications, and ensuring proper healing of the surgical site. Chest tubes, if placed, are monitored and removed as appropriate. Patients may need to stay in the hospital for several days for observation and to ensure that cardiac function is stable. Follow-up care will include regular assessments to evaluate the success of the procedure and the patient's overall cardiac health.
| Short Descr | REPAIR ARTERY W/TUNNEL | Medium Descr | RPR ANOM CORON ART W/CONSTJ INTRAPULM ART TUNNEL | Long Descr | Repair of anomalous coronary artery from pulmonary artery origin; with construction of intrapulmonary artery tunnel (Takeuchi procedure) | 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 | 49 - Other OR heart procedures |
This is a primary code that can be used with these additional add-on codes.
| 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) | 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) |
| 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. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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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| 2006-01-01 | Changed | Code description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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