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The procedure described by CPT® Code 33732 involves the surgical repair of cor triatriatum or a supravalvular mitral ring through the resection of the left atrial membrane. Cor triatriatum, also known as cor triatriatum sinister, is a congenital heart defect where the left atrium is divided into two chambers by a membrane, which can impede normal blood flow. This condition results in the pulmonary veins draining into the upper chamber, leading to potential complications in blood circulation. On the other hand, a supravalvular mitral ring is characterized by an abnormal ridge of tissue located on the atrial side of the mitral valve, which can also restrict blood flow from the left atrium to the left ventricle. The surgical approach typically involves accessing the heart through a median sternotomy or thoracotomy, allowing the surgeon to perform the necessary repairs. The procedure requires the establishment of cardiopulmonary bypass and the initiation of cardioplegic arrest to protect the heart during surgery. The left atrium is then incised to excise the obstructive tissue, whether it be the membrane in cor triatriatum or the ring in supravalvular mitral ring. If the mitral valve requires repair or replacement, this may be addressed in a separate procedure. Following the surgical intervention, the patient is gradually weaned off cardiopulmonary bypass, and any necessary chest tubes are placed before closing the chest incision.
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The procedure is indicated for the following conditions:
The surgical procedure begins with the patient being placed under general anesthesia, followed by the establishment of a median sternotomy or thoracotomy to access the heart. Once access is achieved, cardiopulmonary bypass is initiated to maintain circulation and oxygenation during the surgery. Cardioplegic arrest is then induced to protect the heart muscle from damage during the procedure. An incision is made in the left atrium to allow for direct visualization and access to the obstructive tissue. In cases of cor triatriatum, the surgeon excises the accessory tissue membrane, also referred to as the diaphragm, which is located within the left atrium. This excision is crucial for restoring normal blood flow. In the case of a supravalvular mitral ring, the abnormal tissue ring is carefully dissected away from any adherent mitral valve leaflets and subsequently excised. If the mitral valve is found to be damaged or dysfunctional during the procedure, repair or replacement may be performed as a separately reportable procedure. After the necessary repairs are completed, the patient is gradually weaned off cardiopulmonary bypass. Chest tubes are placed as needed to facilitate drainage, and the chest incision is then closed in layers to ensure proper healing.
Post-procedure care involves monitoring the patient in a recovery area to ensure stable vital signs and adequate respiratory function. The presence of chest tubes will be monitored for drainage, and the patient will be assessed for any signs of complications. Pain management will be provided as necessary, and the patient will be encouraged to engage in gradual mobilization as tolerated. Follow-up imaging may be required to evaluate the success of the repair and to monitor the function of the mitral valve if it was addressed during the procedure. The overall recovery period will vary based on the individual patient's condition and the extent of the surgical intervention performed.
| Short Descr | REPAIR HEART-VEIN DEFECT | Medium Descr | RPR COR TRIATM/SUPVALVR RING RESCJ L ATRIAL MEMB | Long Descr | Repair of cor triatriatum or supravalvular mitral ring by resection of left atrial membrane | 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 | 43 - Heart valve 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). | 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 |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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