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The procedure described by CPT® Code 33602 involves the surgical closure of a semilunar valve, which can either be the aortic or pulmonary valve, using sutures or a patch. This intervention is typically indicated for patients who have single ventricle cardiac anomalies, a condition where one of the heart's ventricles is either absent or underdeveloped. In a normal 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 patients with single ventricle defects, the heart is unable to function normally due to the lack of a fully developed second ventricle. As a result, surgical procedures are necessary to enhance the efficiency of the single functioning ventricle, allowing it to effectively pump blood to both the body and the lungs. These surgical interventions are often performed in multiple stages, and one critical aspect of the surgical process may involve closing one of the atrioventricular or semilunar valves to ensure proper blood flow into the aorta. The surgical access is typically achieved 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. The specific valve targeted for closure is carefully exposed, and depending on the method chosen, either a pericardial patch is placed over the valve or the valve leaflets are sutured together to achieve complete closure.
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The closure of a semilunar valve (aortic or pulmonary) is indicated for patients with specific cardiac conditions, particularly those with single ventricle cardiac anomalies. These anomalies may include:
The procedure for closing a semilunar valve involves several critical steps, which are outlined as follows:
After the closure of the semilunar valve, patients typically require careful monitoring in a postoperative setting. The expected recovery process may involve observation for any complications related to the surgery, such as bleeding or infection. Patients may also need to undergo additional imaging studies to assess the success of the valve closure and overall cardiac function. Follow-up care is essential to ensure that the single ventricle is functioning optimally and that the patient is recovering as expected. Rehabilitation and gradual return to normal activities will be guided by the healthcare team based on the individual patient's condition and response to the procedure.
| Short Descr | CLOSURE OF VALVE | Medium Descr | CLOSURE SEMILUNAR VALVE AORTIC/PULM SUTURE/PATCH | Long Descr | Closure of semilunar valve (aortic or pulmonary) 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). | 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.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 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 | 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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