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The procedure described by CPT® Code 33545 involves the surgical repair of a postinfarction ventricular septal defect (VSD), which may occur following a myocardial infarction, commonly known as a heart attack. A VSD is an abnormal opening in the ventricular septum, the wall dividing the left and right ventricles of the heart. This defect can lead to significant complications, including heart failure and increased pulmonary blood flow. The repair of a postinfarction VSD is critical to restoring normal heart function and preventing further cardiac complications. The procedure may be performed with or without myocardial resection, which involves the removal of damaged heart muscle tissue. This is particularly relevant in cases where the heart has developed a ventricular aneurysm due to extensive damage from a transmural myocardial infarction. The surgical approach typically includes median sternotomy to access the heart, followed by the establishment of cardiopulmonary bypass to maintain circulation during the procedure. The repair techniques can vary, including the use of synthetic patches to close the defect, ensuring that the heart can function effectively post-surgery. Overall, this procedure is essential for patients who have suffered significant cardiac damage and require surgical intervention to correct structural heart defects.
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The procedure described by CPT® Code 33545 is indicated for patients who have developed a postinfarction ventricular septal defect (VSD) following a myocardial infarction. The following conditions may warrant this surgical intervention:
The surgical procedure for CPT® Code 33545 involves several critical steps to effectively repair the postinfarction VSD. The process begins with the exposure of the heart through a median sternotomy, allowing access to the cardiac structures. Cardiopulmonary bypass is then established to maintain blood circulation and oxygenation during the surgery. Following this, the left ventricle is incised near the septal margin to access the defect. A second incision is made in the right ventricle, also close to the septal margin, to expose the VSD. The defect is carefully evaluated to determine the extent of the damage and the necessary repair technique. If myocardial resection is indicated, the non-contractile, scarred heart tissue is excised as previously described. The VSD repair can be performed using various techniques, including a single or double patch method. In the double patch technique, two synthetic patches are utilized; the first patch is placed over the right side of the septum and secured with stay sutures, followed by the placement of a second patch over the left side. Both patches are then secured with a running suture at their peripheries, and glue may be injected between the patches to reinforce the septal tissue. After the repair is completed, strips of felt are placed on the exterior of the heart adjacent to the ventriculotomies, which are then closed using heavy mattress sutures to ensure stability. The ventriculotomy incisions are closed without tension, and the patient is gradually weaned off cardiopulmonary bypass. Finally, chest tubes are placed as necessary to facilitate drainage, and the chest incision is closed to complete the procedure.
After the completion of the procedure, patients typically require close monitoring in a postoperative setting. The expected recovery involves managing any potential complications, such as bleeding or infection, and ensuring that the heart is functioning properly. Patients may have chest tubes in place to drain any excess fluid or blood from the surgical site, which will be monitored and removed as appropriate. The length of hospital stay can vary based on the patient's overall health and the complexity of the surgery, but careful follow-up is essential to assess the success of the VSD repair and the patient's recovery. Cardiac rehabilitation may also be recommended to support the patient's recovery and improve cardiovascular health.
| Short Descr | REPAIR OF HEART DAMAGE | Medium Descr | RPR POSTINFRCJ VENTRICULAR SEPTAL DEFECT | Long Descr | Repair of postinfarction ventricular septal defect, with or without myocardial resection | 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) |
| 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). | 55 | Postoperative management only: when 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number. | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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