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The CPT® Code 33768 refers to the surgical procedure known as an anastomosis of the second superior vena cava to the pulmonary artery. This procedure is typically performed in conjunction with other cardiac surgeries, such as the bidirectional Glenn procedure, outflow tract augmentation, or Fontan procedure, and is specifically applicable to patients who have bilateral superior vena cavae. The primary goal of this procedure is to create a shunt that facilitates blood flow from the second superior vena cava to the pulmonary artery, thereby improving oxygenation and alleviating symptoms associated with certain congenital heart defects. The procedure is classified as a closed heart surgery, which means it is performed without opening the heart itself, and is often utilized as a temporary measure to manage cyanosis—a condition characterized by a bluish discoloration of the skin due to insufficient oxygen in the blood—resulting from various cardiac anomalies, including tetralogy of Fallot. The surgical approach involves a median sternotomy to access the heart and major blood vessels, followed by the establishment of cardiopulmonary bypass to maintain circulation during the procedure. The detailed steps of the anastomosis involve careful manipulation of the superior vena cava and pulmonary artery to ensure proper connection and blood flow, ultimately contributing to the overall management of the patient's cardiac condition.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure coded as CPT® 33768 is indicated for patients with bilateral superior vena cavae who require an anastomosis to the adjacent pulmonary artery. This procedure is typically performed in conjunction with other cardiac interventions, such as:
The procedure begins with the preparation of the patient and the establishment of cardiopulmonary bypass to ensure adequate blood circulation during the surgery. The surgeon performs a median sternotomy to gain access to the heart and major blood vessels. Following this, the azygos and hemiazygos veins are ligated to prevent excessive bleeding. The second superior vena cava is then prepared for the insertion of the bypass cannula. Once prepared, the bypass cannula is inserted into the second superior vena cava, which is subsequently clamped and divided between the clamps. The cardiac end of the second superior vena cava is oversewn to secure it. An incision is made in the adjacent pulmonary artery to facilitate the anastomosis. The second superior vena cava is then anastomosed to the pulmonary artery in an end-to-side fashion, ensuring a proper connection that allows for effective blood flow from the second superior vena cava to the pulmonary artery. After the anastomosis is completed, the clamps are released, and the patient is gradually weaned off cardiopulmonary bypass. Chest tubes may be placed as necessary to manage any fluid accumulation, and the chest incision is then closed.
Post-procedure care involves monitoring the patient for any complications related to the surgery, such as bleeding or infection. Patients are typically observed in a critical care setting for a period following the procedure to ensure stable hemodynamics and adequate respiratory function. The recovery process may include pain management, respiratory support, and gradual mobilization as tolerated. Follow-up imaging may be required to assess the patency of the anastomosis and overall cardiac function. The healthcare team will provide specific instructions regarding activity restrictions and follow-up appointments to monitor the patient's progress and address any concerns that may arise during recovery.
| Short Descr | ANAST CAVOPULM SEC SUP V/C | Medium Descr | ANASTOMOSIS CAVOPULMARY SEC SUPRIOR VENA CAVA | Long Descr | Anastomosis, cavopulmonary, second superior vena cava (List separately in addition to primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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 | 56 - Other vascular bypass and shunt, not heart |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 33478 | MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Outflow tract augmentation (gusset), with or without commissurotomy or infundibular resection | 33617 | MPFS Status: Active Code APC C Illustration for Code Repair of complex cardiac anomalies (eg, single ventricle) by modified Fontan procedure | 33622 | MPFS Status: Active Code APC C Reconstruction of complex cardiac anomaly (eg, single ventricle or hypoplastic left heart) with palliation of single ventricle with aortic outflow obstruction and aortic arch hypoplasia, creation of cavopulmonary anastomosis, and removal of right and left pulmonary bands (eg, hybrid approach stage 2, Norwood, bidirectional Glenn, pulmonary artery debanding) | 33767 | MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Shunt; superior vena cava to pulmonary artery for flow to both lungs (bidirectional Glenn procedure) |
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| 2025-01-01 | Changed | Short and Medium Descriptions changed. |
| 2011-01-01 | Changed | Guideline information changed. |
| 2006-01-01 | Added | First appearance in code book in 2006. |
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