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Closure of an atrioventricular valve, specifically the mitral or tricuspid valve, is a surgical procedure indicated for patients with single ventricle cardiac anomalies. In a typical heart, there are two ventricles: the left ventricle is responsible for pumping oxygenated blood into the aorta and systemic circulation, while the right ventricle pumps deoxygenated blood into the pulmonary arteries and lungs. However, in cases of single ventricle heart defects, one of the ventricles may be absent or underdeveloped, resulting in only one ventricle being capable of effectively pumping blood throughout the body. This condition necessitates surgical interventions aimed at optimizing the function of the single ventricle to ensure adequate blood flow to both the aorta and the lungs. The surgical approach often involves multiple staged procedures. A critical component of the surgical strategy for certain single ventricle anomalies includes the closure of one of the atrioventricular or semilunar valves, which helps direct blood flow into the aorta. The procedure typically requires access to the heart through a median sternotomy, and if a pericardial patch is utilized for closure, the pericardium is incised to harvest the patch. Cardiopulmonary bypass is then initiated to facilitate the procedure. In CPT® Code 33600, the focus is on the closure of either the mitral or tricuspid valve, while CPT® Code 33602 pertains to the closure of either the aortic or pulmonary valve. During the procedure, the selected valve is exposed, and if a pericardial patch is employed, it is placed over the valve. Alternatively, if sutures are used for closure, the valve leaflets are sutured together to achieve complete closure of the valve.
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The closure of an atrioventricular valve is indicated for patients with specific cardiac conditions, particularly those involving single ventricle anomalies. The following are the primary indications for this procedure:
The procedure for the closure of an atrioventricular valve involves several critical steps, which are detailed as follows:
After the closure of the atrioventricular valve, patients typically require careful monitoring and post-operative care. This includes observation in a critical care setting to assess cardiac function and ensure stability. Patients may experience a recovery period that varies based on individual health status and the complexity of the procedure. Follow-up care is essential to monitor for any potential complications, such as valve dysfunction or arrhythmias, and to evaluate the overall effectiveness of the surgical intervention. Rehabilitation and gradual return to normal activities are often part of the recovery process, guided by the healthcare team.
| Short Descr | CLOSURE OF VALVE | Medium Descr | CLOSURE ATRIOVENTRICULAR VALVE SUTURE/PATCH | Long Descr | Closure of atrioventricular valve (mitral or tricuspid) by suture or patch | 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.
| 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) | 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). |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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