CPT® Code 33901

Official Description

Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, bilateral

Common Language Description

Percutaneous pulmonary artery revascularization by stent placement, identified by CPT® Code 33901, is a specialized medical procedure aimed at treating stenotic lesions within the pulmonary artery. These lesions may not respond adequately to balloon angioplasty, 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 heart and blood vessels. It is typically conducted during a cardiac catheterization procedure that may also address 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 point may vary based on the individual patient's anatomy. The procedure begins with the application of lidocaine to numb the access site, followed by puncturing the vein to insert 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 size of the stenotic lesion and surrounding vessels, which informs the selection of the appropriate stent and balloon size for the intervention. This comprehensive approach ensures that the stent placement is tailored to the specific anatomical and pathological conditions of the patient, ultimately aiming to restore normal blood flow through the pulmonary artery.

1. Indications

The procedure of percutaneous pulmonary artery revascularization by stent placement is indicated for the following conditions:

Stenotic Lesions Stenotic lesions of the pulmonary artery that do not achieve satisfactory results from balloon angioplasty.

2. Procedure

The procedure involves several critical steps to ensure successful stent placement in the pulmonary artery:

Step 1: Anesthesia and Access The procedure begins with the patient being placed under general anesthesia to ensure comfort and immobility. Vascular access is typically obtained through a large vein, with the specific site determined by the patient's anatomy. Lidocaine is applied to the access site to minimize discomfort during the puncture.
Step 2: Catheter Insertion After puncturing the vein, a guidewire is introduced, followed by the placement of an introducer sheath. A catheter is then advanced over the guidewire to the target area within the pulmonary artery.
Step 3: Diagnostic Angiography Once the catheter is in place, diagnostic angiograms are performed to visualize the stenotic lesion and surrounding vessels. This imaging is crucial for measuring the lesion and determining the appropriate size of the stent and balloon needed for the procedure.
Step 4: Guidewire Exchange The angiogram catheter is exchanged for an end-hole catheter, which is equipped with a soft guidewire that is advanced just beyond the lesion. This soft guidewire is then replaced with a stiffer, interventional guidewire to facilitate the next steps.
Step 5: Stent Preparation The stent is prepared and mounted onto the delivery balloon. The introducer sheath is exchanged for a delivery sheath, which is advanced over the stiff guidewire to the target area, positioning it just past the pulmonary artery lesion.
Step 6: Stent Positioning The stent on the delivery device is advanced to the tip of the delivery sheath. Once positioned across the lesion, the delivery sheath is partially withdrawn to perform an angiogram for position verification. Adjustments are made as necessary, and the position is visualized again until optimal placement is achieved.
Step 7: Stent Deployment After confirming the stent's position, the delivery sheath is completely withdrawn, and the balloon is deployed to deliver the stent into the lesion. Following this, the delivery balloon is removed.
Step 8: Stent Dilation A larger pressure balloon may be advanced over the guidewire and inflated to dilate the stent to the appropriate diameter, ensuring proper expansion and function.
Step 9: Final Assessment A diagnostic catheter is exchanged for the balloon to assess the results of the stent placement, including stent position and the need for any further intervention.
Step 10: Hemostasis Finally, all instruments are removed, and hemostasis is maintained at the access site to prevent bleeding.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications and ensuring that the access site is stable. Patients may require follow-up imaging to assess the success of the stent placement and to monitor for any potential restenosis or other issues. The healthcare team will provide specific instructions regarding activity restrictions and any necessary medications to support recovery and prevent complications.

Short Descr	PERQ P-ART REVSC 1 NM NT BI
Medium Descr	PERQ P-ART REVSC ST 1ST NML NATIVE CONNJ BI
Long Descr	Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, bilateral
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)	2 - 150% payment adjustment 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)