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Percutaneous pulmonary artery revascularization by stent placement, identified by CPT® Code 33900, is a minimally invasive procedure aimed at treating stenotic lesions within the pulmonary artery. These lesions may not respond adequately to balloon angioplasty alone, necessitating the use of endovascular stents. Stents serve as a supportive structure, providing rigidity to the affected vessel and facilitating improved blood flow. The procedure is performed under general anesthesia and is guided by fluoroscopic imaging, which allows for real-time visualization of the vascular structures. Typically, this intervention is conducted during a cardiac catheterization procedure that is separately reportable, specifically targeting congenital defects in the right and/or left heart. Access to the vascular system is usually achieved through a large vein, although the specific access site may vary based on individual patient anatomy. Prior to the procedure, local anesthesia, such as lidocaine, is administered to the access site to minimize discomfort. The procedure involves puncturing the vein, followed by the placement of a guidewire and introducer sheath. A catheter is then advanced over the guidewire to reach the targeted area of the pulmonary artery. Initial diagnostic angiograms are performed to assess the severity of the stenosis and the dimensions of adjacent vessels, which are critical for selecting the appropriately sized stent and balloon for the intervention. The procedural steps include the exchange of the angiogram catheter for an end-hole catheter, which is equipped with a soft guidewire that is advanced just beyond the stenotic lesion. This soft guidewire is subsequently replaced with a stiffer, interventional guidewire to facilitate the delivery of the stent. The stent is prepared and mounted onto a delivery balloon, and the introducer sheath is exchanged for a delivery sheath that is navigated to the lesion site. Once the stent is positioned correctly across the lesion, the delivery sheath is partially withdrawn to verify the stent's placement through angiography. Adjustments are made as necessary to ensure optimal positioning before the stent is deployed by inflating the delivery balloon. Following deployment, a larger pressure balloon may be used to further dilate the stent to the desired diameter. The procedure concludes with the removal of instruments and ensuring hemostasis at the access site. This code specifically applies to unilateral stent placement through normal native connections in the pulmonary artery.
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The procedure of percutaneous pulmonary artery revascularization by stent placement (CPT® Code 33900) is indicated for the treatment of stenotic lesions in the pulmonary artery that have not responded adequately to balloon angioplasty. The following conditions may warrant this intervention:
The procedure involves several critical steps to ensure successful stent placement in the pulmonary artery:
After the completion of the percutaneous pulmonary artery revascularization procedure, patients are typically monitored for any immediate complications related to the procedure. Expected recovery may involve observation for signs of bleeding or infection at the access site. Patients may also undergo follow-up imaging studies to assess the success of the stent placement and the patency of the pulmonary artery. Additional considerations include managing any underlying conditions that may have contributed to the stenosis and ensuring appropriate follow-up care to monitor the patient's cardiovascular health.
| Short Descr | PERQ P-ART REVSC 1 NM NT UNI | Medium Descr | PERQ P-ART REVSC ST 1ST NML NATIVE CONNJ UNI | Long Descr | Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, unilateral | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | 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) | 0 - Payment restriction for assistants at surgery applies 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 | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
This is a primary code that can be used with these additional add-on codes.
| 33904 | Add-on Code MPFS Status: Active Code APC N Percutaneous pulmonary artery revascularization by stent placement, each additional vessel or separate lesion, normal or abnormal connections (List separately in addition to code for primary procedure) | 93568 | Addon Code MPFS Status: Active Code APC N ASC N1 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for nonselective pulmonary arterial angiography (List separately in addition to code for primary procedure) | 93569 | Add-on Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, unilateral (List separately in addition to code for primary procedure) | 93573 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, bilateral (List separately in addition to code for primary procedure) | 93574 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary venous angiography of each distinct pulmonary vein during cardiac catheterization (List separately in addition to code for primary procedure) | 93575 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary angiography of major aortopulmonary collateral arteries (MAPCAs) arising off the aorta or its systemic branches, during cardiac catheterization for congenital heart defects, each distinct vessel (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). | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2023-01-01 | Added | Code added. |
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