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The procedure described by CPT® Code 33660 involves the surgical repair of an incomplete or partial atrioventricular canal, specifically known as an ostium primum atrial septal defect. This condition is a type of atrioventricular septal defect (AVSD), which is characterized by a defect in the heart's septum that separates the atria and ventricles. The endocardial cushions, which are embryonic structures, play a crucial role in the development of the heart's central structures, including the atrial and ventricular septa, as well as the tricuspid and mitral valves. In cases of partial AVSD, there is a partial filling of the ventricular septum with tissue, leading to the formation of two distinct atrioventricular valves. The surgical procedure typically requires a median sternotomy to access the heart, followed by the establishment of cardiopulmonary bypass to facilitate the repair. The operation includes inspecting and repairing the tricuspid and mitral valves, closing the atrial septal defect, and ensuring the overall competence of the heart valves to prevent future complications. This procedure is critical for restoring normal heart function and preventing further cardiac issues associated with AVSD.
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The procedure described by CPT® Code 33660 is indicated for patients with an incomplete or partial atrioventricular canal, specifically an ostium primum atrial septal defect. This condition may present with various symptoms and complications, including:
The surgical procedure for CPT® Code 33660 involves several critical steps to repair the atrioventricular septal defect. The process begins with a median sternotomy, which is a surgical incision made along the sternum to provide access to the heart. Following this, bicaval and aortic cannulas are inserted to establish cardiopulmonary bypass, allowing the heart to be temporarily stopped and blood to be diverted to a heart-lung machine. Cardioplegic arrest is then initiated to protect the heart muscle during the repair.
Once the heart is accessed, the pericardium is incised, and a patch is harvested for the repair of the septal defect. An atriotomy is performed by incising the right atrium to expose the atrioventricular septal defect. The tricuspid and mitral valves are carefully inspected for size and competence. The cleft in the mitral valve is repaired first through the septal defect, ensuring that the valve functions properly and does not lead to stenosis. Any defects in the tricuspid valve are also addressed during this step.
After the valve repairs, the atrial septal defect (ASD) is closed. This can be accomplished using a patch of pericardium or, in cases where the ASD is small, with sutures. If additional defects are present, such as a small ventricular septal defect (VSD), they may be addressed in conjunction with the ASD closure. The procedure may also involve tailoring the common atrioventricular valve to ensure proper function and prevent future complications.
Once all repairs are completed, the right atrial incision is closed, and the patient is gradually weaned off cardiopulmonary bypass. Chest tubes may be placed as needed to drain any excess fluid, and the chest incision is subsequently closed to complete the procedure.
After the completion of the surgical repair, patients typically require close monitoring in a postoperative setting. Expected recovery includes observation for any complications such as bleeding, infection, or issues related to the repaired valves. Patients may experience some discomfort and will be managed with appropriate pain relief. The duration of the hospital stay can vary based on individual recovery but generally involves several days of monitoring before discharge. Follow-up appointments are essential to assess the success of the repair and the overall function of the heart, ensuring that the patient is recovering well and that no further interventions are necessary.
| Short Descr | REPAIR OF HEART DEFECTS | Medium Descr | RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR | Long Descr | Repair of incomplete or partial atrioventricular canal (ostium primum atrial septal defect), with or without atrioventricular valve repair | 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). | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 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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| Pre-1990 | Added | Code added. |
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