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The procedure described by CPT® Code 33692 involves the complete surgical repair of tetralogy of Fallot (TOF) in neonates, specifically when pulmonary atresia is not present. Tetralogy of Fallot is a complex congenital heart defect characterized by four specific abnormalities: pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect (VSD), and overriding aorta. Pulmonary stenosis refers to the narrowing of the pulmonary valve and the outflow tract, which obstructs blood flow from the right ventricle to the pulmonary artery. This obstruction leads to increased pressure in the right ventricle, resulting in right ventricular hypertrophy, which is the thickening of the muscular walls of the right ventricle. The VSD is a defect that consists of one or more holes in the ventricular septum, allowing for abnormal blood flow between the heart's ventricles. The overriding aorta is a condition where the aorta is positioned directly above the VSD, receiving blood from both the right and left ventricles, which can lead to mixing of oxygenated and deoxygenated blood. During the surgical procedure, the heart is accessed through a median sternotomy, and cardiopulmonary bypass is established to maintain circulation while the heart is stopped using cardioplegic arrest. The VSD is repaired using a synthetic patch, which effectively closes the defect and prevents the mixing of blood. The pulmonary valve is addressed by resecting obstructive tissue to alleviate the stenosis, and if necessary, a transannular patch may be placed to enlarge the outflow tract. In cases where pulmonary atresia is present, a conduit is created from the right ventricle to the pulmonary artery to ensure proper blood flow to the lungs. This comprehensive approach aims to correct the anatomical defects associated with TOF, allowing for improved oxygenation and overall cardiac function in the neonate.
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The procedure is indicated for neonates diagnosed with tetralogy of Fallot (TOF) without pulmonary atresia. The following conditions are typically present:
The surgical procedure for the complete repair of tetralogy of Fallot without pulmonary atresia involves several critical steps:
After the procedure, the neonate will be closely monitored in a pediatric intensive care unit (PICU) for any complications. Expected recovery includes observation for signs of infection, monitoring of vital signs, and ensuring adequate oxygenation. The surgical team will assess the heart function and may perform echocardiograms to evaluate the success of the repair. Follow-up care will be necessary to monitor the child's growth and development, as well as to manage any long-term effects of the congenital heart defect and the surgical intervention.
| Short Descr | COMP RPR TOF WO PULM ATRESIA | Medium Descr | COMPL RPR TETRALOGY FALLOT W/O PULM ATRESIA | Long Descr | Complete repair tetralogy of Fallot without pulmonary atresia; | 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) |
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| 2025-01-01 | Changed | Short Description changed. |
| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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