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The procedure described by CPT® Code 33724 involves the surgical repair of isolated partial anomalous pulmonary venous return, which is a specific type of congenital heart defect. In this condition, not all four pulmonary veins return to the left atrium as they normally should; instead, some of these veins, particularly the right pulmonary veins, drain abnormally into the right side of the heart, such as the superior vena cava, right atrium, or inferior vena cava. This abnormality can lead to a situation where oxygenated blood is returned to the systemic venous side of the circulatory system rather than being properly circulated throughout the body. The condition may remain asymptomatic until middle age, making it challenging to diagnose early. The surgical approach typically involves a midline sternotomy, which allows the surgeon to access the heart directly. During the procedure, cardiopulmonary bypass is initiated to maintain circulation while the heart is manipulated. The surgeon then visualizes and dissects the anomalously draining pulmonary veins from their incorrect insertion points. The goal of the surgery is to redirect these veins so that they drain into the left atrium, restoring normal pulmonary venous return. Additionally, if there is an associated atrial septal defect, the surgeon will close this defect by suturing a patch over the hole, further improving the patient's hemodynamics and overall heart function.
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The procedure is indicated for patients diagnosed with isolated partial anomalous pulmonary venous return, which may present with the following conditions:
The surgical procedure for the repair of isolated partial anomalous pulmonary venous return involves several critical steps:
After the completion of the surgical repair, patients are typically monitored in a recovery area before being transferred to a hospital ward. Post-procedure care includes close observation for any signs of complications, such as bleeding or infection. Patients may require pain management and support for respiratory function as they recover from the effects of anesthesia and the surgical intervention. The expected recovery period can vary, but patients are generally advised to follow up with their healthcare provider for ongoing assessment of heart function and overall health. Rehabilitation and gradual return to normal activities are often recommended, depending on the individual’s recovery progress and any additional underlying conditions.
| Short Descr | REPAIR VENOUS ANOMALY | Medium Descr | REPAIR ISOLATED PARTIAL PULM VENOUS RETURN | Long Descr | Repair of isolated partial anomalous pulmonary venous return (eg, Scimitar Syndrome) | 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) | P1G - Major procedure - 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). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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 | LT | Left side (used to identify procedures performed on the left side of the body) | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study |
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| 2007-01-01 | Added | First appearance in code book in 2007. |
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