CPT® Code 33904 | Case2Code

Official Description

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)

Common Language Description

The CPT® Code 33904 refers to the procedure of percutaneous pulmonary artery revascularization by stent placement, specifically for each additional vessel or separate lesion. This procedure is indicated for patients with stenotic lesions in the pulmonary artery that have not responded adequately to balloon angioplasty. The use of endovascular stents provides a more rigid structure to support 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. It is typically conducted in conjunction with a right and/or left heart cardiac catheterization, particularly for congenital defects. The vascular access for this procedure is usually obtained through a large vein, although the specific approach may vary based on the patient's unique 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, placing a guidewire and introducer sheath, and advancing a catheter to the target area. Diagnostic angiograms are performed to assess the stenotic lesion and surrounding vessels, which aids in selecting the appropriate size stent and balloon for the intervention. The stent placement process involves several critical steps, including the exchange of catheters and guidewires, positioning the stent across the lesion, and deploying the stent using a delivery balloon. Post-deployment, further assessments are conducted to ensure optimal stent placement and function. This code is specifically used to report each additional stent placed, whether through normal or abnormal connections, and is listed separately in addition to the primary procedure codes for initial stent placements.

1. Indications

The procedure associated with CPT® Code 33904 is indicated for the treatment of stenotic lesions in the pulmonary artery that have not achieved satisfactory results from balloon angioplasty. The following conditions may warrant the use of this procedure:

Stenotic Lesions Lesions in the pulmonary artery that are narrowed and impede blood flow.
Congenital Defects Structural heart defects present at birth that may lead to abnormal blood flow patterns.
Failure of Balloon Angioplasty Cases where previous attempts at balloon angioplasty have not resulted in adequate vessel dilation.

2. Procedure

The procedure for CPT® Code 33904 involves several detailed steps to ensure successful stent placement in the pulmonary artery. The following outlines the procedural steps:

Step 1: Anesthesia and Access The procedure begins with the patient receiving general anesthesia to ensure comfort and immobility during the intervention. Vascular access is typically obtained through a large vein, with the specific site chosen based on the patient's anatomy. Lidocaine is applied to the access site to numb the area before puncturing the vein.
Step 2: Catheter Insertion A guidewire is introduced into the vein, followed by the placement of an introducer sheath. A catheter is then advanced over the guidewire to reach the target area in 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, positioned just past the pulmonary artery lesion.
Step 6: Stent Positioning The stent on the delivery device is carefully advanced to the tip of the delivery sheath. Once positioned across the lesion, the delivery sheath is partially withdrawn to perform an angiogram for verification of the stent's position. 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 deployment, the delivery balloon is removed.
Step 8: Final Assessment A larger pressure balloon may be advanced over the wire and inflated to dilate the stent to the appropriate diameter. A diagnostic catheter is then exchanged for the balloon to assess the results, stent position, and determine if any further intervention is required.
Step 9: Completion Once the procedure is complete, all instruments are removed, and hemostasis is maintained at the access site to prevent bleeding.

3. Post-Procedure

After the completion of the stent placement procedure, patients are typically monitored for any immediate complications or adverse reactions. Post-procedure care may include managing the access site to ensure proper healing and preventing infection. Patients may also undergo follow-up imaging studies to assess the stent's position and function. The expected recovery time can vary based on individual patient factors and the complexity of the procedure, but close monitoring is essential to ensure optimal outcomes and address any potential issues promptly.

Short Descr	PERQ P-ART REVSC EACH ADDL
Medium Descr	PERQ P-ART REVSC ST EA ADDL VSL/SEP LES NM/ABNL
Long Descr	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)
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)	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	Items and Services Packaged into APC Rates
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	1

This is an add-on code that must be used in conjunction with one of these primary codes.

33900	MPFS Status: Active Code APC J1 ASC J8 Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, unilateral
33901	MPFS Status: Active Code APC J1 ASC J8 Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, bilateral
33902	MPFS Status: Active Code APC J1 ASC J8 Percutaneous pulmonary artery revascularization by stent placement, initial; abnormal connections, unilateral
33903	MPFS Status: Active Code APC J1 ASC J8 Percutaneous pulmonary artery revascularization by stent placement, initial; abnormal connections, bilateral
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)