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Direct or patch closure of a sinus venosus type defect is a surgical procedure aimed at correcting a specific type of atrial septal defect known as sinus venosus atrial septal defect (SVASD). This defect is characterized by an abnormal opening in the upper part of the atrial septum, which separates the right and left atria of the heart. The most prevalent form of this defect is located near the superior vena cava, often accompanied by anomalous pulmonary venous drainage, where the right upper pulmonary vein drains into the superior vena cava instead of the left atrium. There are variations of this defect, including one that occurs at the junction of the right atrium and inferior vena cava, which may involve the right lower pulmonary vein draining into the inferior vena cava. The least common variant is situated posterior to the fossa ovalis and does not involve the major venous structures. The surgical approach typically involves a median sternotomy or an upper hemisternotomy to access the heart. Once the heart is accessed, cardiopulmonary bypass is established to maintain circulation while the heart is temporarily stopped. The procedure involves incising the right atrium to expose the defect, followed by either direct suturing for smaller defects or the use of a patch graft for larger defects that involve the vena cava. This intervention not only closes the septal defect but also corrects any associated anomalous pulmonary venous drainage, thereby restoring normal blood flow within the heart.
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The procedure of direct or patch closure of a sinus venosus type defect is indicated for the following conditions:
The procedure for direct or patch closure of a sinus venosus type defect involves several critical steps:
After the procedure, patients typically require close monitoring in a postoperative setting. Expected recovery includes observation for any complications such as bleeding or infection. The placement of chest tubes may be necessary to drain any excess fluid or air from the thoracic cavity. Patients are usually weaned off ventilatory support as they stabilize. The overall recovery time can vary based on individual patient factors, but many patients can expect to resume normal activities within a few weeks, pending their physician's guidance. Follow-up appointments are essential to monitor heart function and ensure the success of the repair.
| Short Descr | REVISION OF HEART VEINS | Medium Descr | DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG | Long Descr | Direct or patch closure, sinus venosus, with or without anomalous pulmonary venous drainage | 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) | 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). | 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 | RT | Right side (used to identify procedures performed on the right side of the body) |
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| Pre-1990 | Added | Code added. |
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