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The procedure described by CPT® Code 33702 involves the surgical repair of a sinus of Valsalva fistula, which is performed with the assistance of cardiopulmonary bypass. The sinus of Valsalva refers to the three anatomical recesses located in the proximal portion of the aorta, corresponding to the three cusps of the aortic valve. A fistula in this area is typically a congenital defect, but it can also arise from other causes such as penetrating or non-penetrating trauma to the chest, complications following surgical procedures, or as a result of endocarditis. During the procedure, cardiopulmonary bypass is established through the use of venous and arterial cannulation, allowing for the heart to be temporarily stopped and blood to be diverted. The ascending aorta is clamped, and an incision is made to access the aorta, where the defect in the sinus of Valsalva is located. The surgical team inspects the aortic valve cusps and the coronary ostia to ensure there are no additional issues. The repair of the fistula is accomplished using sutures or by placing a patch made of pericardial or synthetic material. Once the repair is completed, the ascending aorta is closed, restoring normal blood flow. This procedure is critical for addressing the complications associated with a sinus of Valsalva fistula and preventing further cardiovascular issues.
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The repair of a sinus of Valsalva fistula with cardiopulmonary bypass is indicated in the following situations:
The procedure for repairing a sinus of Valsalva fistula with cardiopulmonary bypass involves several critical steps:
Post-procedure care following the repair of a sinus of Valsalva fistula typically involves monitoring the patient in a critical care setting to ensure stable hemodynamics and recovery from anesthesia. Patients may require close observation for any signs of complications, such as bleeding or infection. The recovery period may vary depending on the individual patient's condition and the complexity of the procedure. Follow-up imaging studies may be necessary to assess the success of the repair and to monitor for any potential recurrence of the fistula. Additionally, patients may need to adhere to specific activity restrictions and follow-up appointments to ensure optimal recovery and management of their cardiovascular health.
| Short Descr | REPAIR OF HEART DEFECTS | Medium Descr | RPR SINUS VALSALVA FISTULA | Long Descr | Repair sinus of Valsalva fistula, with cardiopulmonary bypass; | 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). | 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 | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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