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The procedure described by CPT® Code 33647 involves the surgical repair of two specific congenital heart defects: the atrial septal defect (ASD) and the ventricular septal defect (VSD). An ASD is characterized by an abnormal opening in the interatrial septum, which is the wall separating the right and left atria, the upper chambers of the heart. This defect allows for the mixing of oxygenated blood from the left atrium with unoxygenated blood from the right atrium, potentially leading to various complications, including heart failure and pulmonary hypertension. Similarly, a VSD is defined as an abnormal opening in the interventricular septum, the wall separating the right and left ventricles, the lower chambers of the heart. This defect permits the mixing of oxygenated blood from the left ventricle with unoxygenated blood from the right ventricle, which can also result in significant clinical issues if left untreated. The surgical approach to repair these defects typically involves accessing the heart through a median sternotomy, which entails making an incision along the sternum to gain direct access to the heart. Once the heart is accessed, the pericardium, the protective sac surrounding the heart, is incised, and a graft of pericardium may be harvested if necessary for the repair. The procedure is performed under cardiopulmonary bypass, which temporarily takes over the function of the heart and lungs, allowing the surgeon to operate on a still and bloodless field. The right atrium is opened to facilitate the closure of the ASD, which can be accomplished using sutures or by placing a patch over the defect. The patch may be made from the harvested pericardium or synthetic material, depending on the specific requirements of the repair. Following the closure of the ASD, the VSD is addressed through various possible incisions, including those in the right atrium, pulmonary artery, or the outflow tract of the right ventricle. The defect is then sutured closed or patched similarly to the ASD repair. After completing the repairs, the heart incisions are closed, and the cardiopulmonary bypass is discontinued, followed by the placement of chest tubes and closure of the chest incision. This comprehensive approach aims to restore normal blood flow and function within the heart, addressing the complications associated with these congenital defects.
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The procedure described by CPT® Code 33647 is indicated for patients diagnosed with the following conditions:
The surgical procedure for the repair of ASD and VSD involves several critical steps, each aimed at effectively closing the defects to restore normal cardiac function.
Post-procedure care following the repair of ASD and VSD typically involves monitoring the patient in a recovery area or intensive care unit. The placement of chest tubes is essential for managing any fluid accumulation and ensuring proper lung expansion. Patients are closely observed for any signs of complications, such as bleeding or infection. The expected recovery period may vary based on the individual patient's health status and the complexity of the surgery, but generally, patients can expect to stay in the hospital for several days. Follow-up appointments will be necessary to assess the success of the repairs and monitor the patient's overall cardiac function.
| Short Descr | REPAIR HEART SEPTUM DEFECTS | Medium Descr | RPR ATRIAL & VENTRIC SEPTAL DFCT DIR/PATCH CLS | Long Descr | Repair of atrial septal defect and ventricular septal defect, with direct or patch closure | 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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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| 2013-01-01 | Changed | Medium Descriptor changed. |
| Pre-1990 | Added | Code added. |
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