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Reconstruction of a complex cardiac anomaly involves a surgical procedure aimed at correcting significant congenital heart defects, particularly those that affect the normal flow of blood through the heart and to the body. This specific procedure, identified by CPT® Code 33622, is typically performed as the second stage of a hybrid approach to treatment. Such anomalies often include conditions like hypoplastic left heart syndrome, where the left side of the heart is underdeveloped, leading to a reliance on the right ventricle to manage both pulmonary and systemic blood flow. The surgical intervention is critical to establish a more balanced circulation, ensuring that adequate blood reaches both the lungs for oxygenation and the rest of the body to support its functions. The procedure is complex and requires careful planning and execution, as it involves multiple steps to reconstruct the heart's anatomy and improve its functionality. The use of median sternotomy allows access to the heart, and techniques such as cardiopulmonary bypass and hypothermic circulatory arrest are employed to facilitate the surgery while minimizing risks to the patient. Overall, this reconstruction aims to enhance the patient's quality of life and improve long-term outcomes for those with severe cardiac anomalies.
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The reconstruction of a complex cardiac anomaly, as described by CPT® Code 33622, is indicated for patients with specific congenital heart defects that require surgical intervention to improve blood flow and heart function. The following conditions are explicitly mentioned as indications for this procedure:
The procedure for reconstructing a complex cardiac anomaly involves several critical steps, each designed to address the specific anatomical challenges presented by the patient's condition. The following procedural steps are performed:
After the reconstruction of the complex cardiac anomaly, the patient will require careful monitoring and post-operative care. This includes observation in a critical care setting to assess heart function, manage fluid balance, and monitor for any potential complications. The placement of chest tubes will help drain any excess fluid or blood from the surgical site, promoting healing and reducing the risk of infection. Patients may experience a recovery period that varies in length, depending on their overall health and the complexity of the surgery. Follow-up appointments will be necessary to evaluate the success of the procedure and to monitor the patient's ongoing cardiac function and development.
| Short Descr | REDO COMPL CARDIAC ANOMALY | Medium Descr | RECONSTRUCTION COMPLEX CARDIAC ANOMALY | Long Descr | Reconstruction of complex cardiac anomaly (eg, single ventricle or hypoplastic left heart) with palliation of single ventricle with aortic outflow obstruction and aortic arch hypoplasia, creation of cavopulmonary anastomosis, and removal of right and left pulmonary bands (eg, hybrid approach stage 2, Norwood, bidirectional Glenn, pulmonary artery debanding) | 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.
| 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) | 33768 | Addon Code MPFS Status: Active Code APC C Illustration for Code Anastomosis, cavopulmonary, second superior vena cava (List separately in addition to 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). | 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. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery |
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| 2011-01-01 | Added | Added |
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