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The procedure described by CPT® Code 33903 refers to the percutaneous pulmonary artery revascularization by stent placement, specifically for initial interventions involving abnormal connections in a bilateral context. This procedure is indicated for patients with stenotic lesions in the pulmonary artery that have not responded adequately to balloon angioplasty, a common treatment for such conditions. The use of endovascular stents provides a more stable and supportive structure to the affected vessel, thereby improving blood flow and reducing the risk of further complications. The procedure is performed under general anesthesia and utilizes fluoroscopic guidance, which allows for real-time imaging during the intervention. This is typically done in conjunction with a cardiac catheterization procedure that may involve the right and/or left heart to assess congenital defects. Access to the vascular system is usually achieved through a large vein, although the specific approach may vary based on the individual patient's anatomy. The procedure involves several critical steps, including the application of local anesthetic, puncturing the access site, and advancing a guidewire and introducer sheath into the vein. Following this, a catheter is navigated to the target area, where diagnostic angiograms are performed to evaluate the stenotic lesions and surrounding vessels. The careful selection and placement of the stent are crucial for the success of the procedure, ensuring that the stent is optimally positioned to restore proper blood flow through the pulmonary artery.
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The procedure is indicated for the following conditions:
The procedure involves several critical steps to ensure successful stent placement in the pulmonary artery. First, the patient is placed under general anesthesia to ensure comfort and immobility during the intervention. Fluoroscopic guidance is utilized throughout the procedure to provide real-time imaging of the vascular structures. Access to the vascular system is typically achieved through a large vein, although the specific site may vary based on the patient's anatomy. Lidocaine is applied to the access site to minimize discomfort during the puncture. A needle is then used to puncture the vein, followed by the insertion of a guidewire and introducer sheath into the vascular access point.
Once access is established, a catheter is advanced over the guidewire to the target area within the pulmonary artery. Diagnostic angiograms are performed to visualize the stenotic lesions and measure their dimensions, as well as to assess the surrounding vessels. Based on the angiographic findings, the appropriate size stent and balloon are selected for the procedure. The angiogram catheter is exchanged for an end-hole catheter, which is equipped with a soft guidewire that is advanced just beyond the lesion.
Next, the soft guidewire is replaced with a stiffer, interventional guidewire to facilitate the delivery of the stent. The stent is prepared and mounted onto the delivery balloon. The introducer sheath is then exchanged for a delivery sheath, which is advanced over the stiff guidewire to the target area, positioning it just past the stenotic lesion in the pulmonary artery. The stent on the delivery device is carefully advanced to the tip of the delivery sheath. Once the stent is 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 to ensure optimal placement.
After confirming the stent's position, the delivery sheath is completely withdrawn, and the balloon is deployed to deliver the stent into the vessel. Following the deployment, the delivery balloon is removed, and a larger pressure balloon may be advanced over the guidewire and inflated to dilate the stent to the appropriate diameter. A diagnostic catheter is then exchanged for the balloon to assess the results, including the stent position and the need for any further interventions. Finally, all instruments are removed, and hemostasis is maintained at the access site to complete the procedure.
Post-procedure care involves monitoring the patient for any complications related to the stent placement and ensuring that hemostasis is maintained at the access site. Patients may require follow-up imaging to assess the success of the stent placement and to monitor for any potential restenosis or other vascular issues. The healthcare team will provide specific instructions regarding activity restrictions, medication management, and signs of complications that the patient should be aware of as they recover from the procedure.
| Short Descr | PERQ P-ART REVSC 1 ABNOR BI | Medium Descr | PERQ P-ART REVSC ST 1ST ABNORMAL CONNJ BILATERAL | Long Descr | Percutaneous pulmonary artery revascularization by stent placement, initial; abnormal 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) |
| 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 |
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| 2023-01-01 | Added | Code added. |
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