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The procedure described by CPT® Code 33608 involves the repair of a complex cardiac anomaly, specifically excluding pulmonary atresia with ventricular septal defect. This surgical intervention is aimed at constructing or replacing a conduit that connects either the right or left ventricle to the pulmonary artery. A conduit, in this context, refers to a tubular graft that can be fabricated from synthetic materials or derived from cadaver donor aortic or arterial grafts. The conduit may be designed with or without a valve, depending on the specific requirements of the patient's condition. This procedure is particularly indicated for addressing ventricular outflow tract anomalies or complications that arise from previous cardiac surgeries, which may lead to obstructions in the outflow tract of the right or left ventricle. The surgical approach typically involves a median sternotomy, which provides access to the heart. During the procedure, cardiopulmonary bypass is established to maintain circulation and oxygenation while the heart is temporarily stopped, and cardioplegia is initiated to protect the heart muscle. The surgeon then incises the right or left ventricle to examine the outflow tract, followed by the suturing of the conduit to the ventricle at the site of ventriculotomy. Subsequently, the main pulmonary artery is incised, and the conduit is sutured to it, ensuring proper connection for blood flow. After completing the necessary repairs, the heart is closed, and cardiopulmonary bypass is discontinued. Finally, chest tubes are placed to facilitate drainage, and the chest incision is closed to complete the procedure.
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The procedure described by CPT® Code 33608 is indicated for the treatment of specific cardiac conditions that involve complex anomalies of the heart. These include:
The procedure for CPT® Code 33608 involves several critical steps to ensure the successful repair of the cardiac anomaly. These steps include:
Post-procedure care following the repair of a complex cardiac anomaly via CPT® Code 33608 involves monitoring the patient closely for any complications. Patients typically require intensive care following surgery to ensure proper recovery. Expected recovery includes managing pain, monitoring for signs of infection, and ensuring that the heart is functioning correctly. The placement of chest tubes will allow for the drainage of any excess fluid, and these will be monitored and removed as necessary. Follow-up imaging may be required to assess the integrity of the conduit and the overall function of the heart. Rehabilitation and gradual return to normal activities will be guided by the healthcare team based on the patient's recovery progress.
| Short Descr | REPAIR ANOMALY W/CONDUIT | Medium Descr | RPR CAR ANOMAL XCP PULM ATRESIA VENTR SEPTL DFCT | Long Descr | Repair of complex cardiac anomaly other than pulmonary atresia with ventricular septal defect by construction or replacement of conduit from right or left ventricle to pulmonary artery | 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) | 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) |
| 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). | 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 |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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