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The procedure described by CPT® Code 33612 involves the surgical repair of a double outlet right ventricle (DORV) with the use of an intraventricular tunnel repair, in conjunction with the correction of right ventricular outflow tract obstruction. DORV is a congenital heart defect characterized by both the aorta and pulmonary artery originating from the right ventricle, which can lead to significant hemodynamic complications. In this procedure, the surgeon creates an intraventricular tunnel, which serves as a conduit for blood flow from the left ventricle through a ventricular septal defect (VSD) to the aorta. This is crucial for ensuring adequate oxygenation of the blood, as the left ventricle typically supplies oxygen-rich blood to the body. The surgical approach begins with the establishment of cardiopulmonary bypass, allowing the heart to be temporarily stopped and providing a bloodless field for the operation. The right atrium is incised to gain access to the heart's internal structures, where the VSD is visualized and assessed in relation to the aorta. Depending on the size and position of the VSD, the surgeon may either approach it through the tricuspid valve or make an incision in the right ventricle. The creation of the tunnel involves careful dissection and suturing techniques to ensure that the new pathway for blood flow is both functional and anatomically correct. In addition to the tunnel repair, the procedure addresses any obstruction in the right ventricular outflow tract, which may occur due to the bulging of the tunnel. This is rectified by enlarging the right ventricle with an autologous pericardial patch, which is a piece of the patient's own pericardium used to reinforce the heart structure. The meticulous nature of this surgery requires a thorough understanding of cardiac anatomy and surgical techniques to achieve optimal outcomes for patients with this complex congenital condition.
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The procedure described by CPT® Code 33612 is indicated for patients diagnosed with double outlet right ventricle (DORV), a congenital heart defect where both the aorta and pulmonary artery arise from the right ventricle. This condition often coexists with a ventricular septal defect (VSD), which is critical for blood flow from the left ventricle. The indications for performing this surgical repair include:
The surgical procedure for CPT® Code 33612 involves several critical steps to repair the DORV and address the right ventricular outflow tract obstruction:
Post-procedure care following the repair of DORV with CPT® Code 33612 involves close monitoring of the patient in a postoperative setting. Patients typically require intensive care to manage hemodynamic stability and monitor for any complications. Recovery may include pain management, monitoring for signs of infection, and ensuring proper cardiac function. Follow-up echocardiograms may be necessary to assess the success of the repair and the function of the heart structures. The length of recovery can vary based on the individual patient's condition and response to surgery.
| Short Descr | REPAIR DOUBLE VENTRICLE | Medium Descr | RPR 2 OUTLET R VNTRC RPR R VENTR O/F TRC OBSTRCJ | Long Descr | Repair of double outlet right ventricle with intraventricular tunnel repair; with repair of right ventricular outflow tract obstruction | 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) |
| 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). | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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