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The procedure described by CPT® Code 33720 involves the surgical repair of a sinus of Valsalva aneurysm using cardiopulmonary bypass. The sinus of Valsalva refers to the three aortic sinuses located within the pericardium at the uppermost part of the aorta, just above the aortic valve cusps. An aneurysm in this area can arise from either congenital or acquired conditions. Congenital aneurysms are rare and typically affect only one sinus, while acquired aneurysms may develop due to various factors such as Marfan syndrome, syphilitic aortitis, cystic medial necrosis, atherosclerosis, the natural aging process, or trauma to the chest. The surgical approach begins with a median sternotomy to gain access to the heart. Following this, venous and arterial cannulas are inserted to establish cardiopulmonary bypass, allowing the heart to be temporarily stopped and the aorta to be cross-clamped. The procedure involves careful exploration and repair of the aneurysm, which may include the removal of any thrombus present, suturing the aneurysm, and possibly using a patch graft for reinforcement. The aorta is then reconstructed, and the patient is gradually taken off bypass, with appropriate post-operative care initiated.
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The procedure for repairing a sinus of Valsalva aneurysm with cardiopulmonary bypass is indicated for patients presenting with the following conditions:
The surgical procedure for repairing a sinus of Valsalva aneurysm involves several critical steps:
After the surgical repair of the sinus of Valsalva aneurysm, the patient will require careful monitoring in a post-operative setting. Expected recovery includes observation for any complications such as bleeding or infection. The placement of chest tubes will facilitate the drainage of any excess fluid, and the patient will be assessed for stable hemodynamics as they are weaned off cardiopulmonary bypass. Follow-up care will involve regular evaluations to ensure proper healing and function of the heart and aorta.
| Short Descr | REPAIR OF HEART DEFECT | Medium Descr | RPR SINUS VALSALVA ANEURYSM | Long Descr | Repair sinus of Valsalva aneurysm, 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) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 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 | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| Pre-1990 | Added | Code added. |
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