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The procedure described by CPT® Code 33735 involves an atrial septectomy or septostomy performed using a closed heart technique, specifically known as the Blalock-Hanlon type operation. This surgical intervention is primarily aimed at improving oxygen saturation in patients who present with transposition anomalies of the great vessels, a condition where the major arteries are incorrectly positioned. The procedure is conducted through a right lateral thoracotomy, which is an incision made on the side of the chest to access the heart without the need for cardiopulmonary bypass. During the operation, the physician places clamps on a small segment of both the right and left atria to temporarily occlude blood flow. This allows for the creation of two parallel incisions—one in the right atrium and one in the left atrium—near the septum. The intra-atrial septum is then manipulated, with the posterior aspect being excised to facilitate improved blood flow and oxygenation. After the necessary modifications to the septum are made, the clamps are repositioned, allowing the septum to fall back into the atrial cavity, and the incisions in the atria are subsequently closed. This closed heart approach is contrasted with the open heart technique described in CPT® Code 33736, which involves the use of cardiopulmonary bypass and is typically reserved for cases where the atrial septum is particularly thick.
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The atrial septectomy or septostomy procedure, as described by CPT® Code 33735, is indicated for patients with specific cardiac conditions that necessitate improved oxygen saturation. The primary indications include:
The procedure for CPT® Code 33735 involves several critical steps to ensure the successful performance of the atrial septectomy or septostomy using a closed heart technique. The steps are as follows:
After the completion of the atrial septectomy or septostomy, the patient is monitored closely for any complications. Post-procedure care typically includes managing the patient's recovery in a controlled environment, monitoring vital signs, and ensuring that the heart functions properly. The patient may require additional support, such as oxygen therapy, to assist with recovery. Follow-up evaluations are essential to assess the effectiveness of the procedure and to monitor for any potential complications that may arise in the postoperative period.
| Short Descr | REVISION OF HEART CHAMBER | Medium Descr | ATRIAL SEPTECTOMY/SEPTOSTOMY CLOSED HEART | Long Descr | Atrial septectomy or septostomy; closed heart (Blalock-Hanlon type operation) | 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) | 0 - Co-surgeons not permitted for this procedure. | 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) | 33258 | 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), without 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) |
| 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). |
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| Pre-1990 | Added | Code added. |
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