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The procedure described by CPT® Code 33925 involves the surgical repair of pulmonary artery arborization anomalies through a technique known as unifocalization, which is performed without the use of cardiopulmonary bypass. Arborization anomalies are often associated with congenital heart defects, particularly pulmonary atresia and ventricular septal defects (VSD). These anomalies manifest as collateral arteries, commonly referred to as major aorto-pulmonary collateral arteries (MAPCAs), which serve as alternative pathways for blood flow between the aorta and the pulmonary arteries. The goal of the unifocalization procedure is to connect these collateral arteries and create a more centralized confluence, thereby improving blood flow to the lungs. The surgical approach typically involves either a median sternotomy or a thoracotomy, allowing access to the heart. In cases where cardiopulmonary bypass is not utilized, the procedure focuses on mobilizing and connecting the MAPCAs directly to the pulmonary artery. This is a critical first step in a staged repair process for patients with multiple cardiac anomalies. The careful dissection and mobilization of the collateral arteries, along with the management of branch vessels, are essential components of the procedure to ensure proper anastomosis and minimize complications. The use of this code is specifically indicated when the procedure is performed without the assistance of cardiopulmonary bypass, distinguishing it from similar procedures that may require such support.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 33925 is indicated for patients presenting with pulmonary artery arborization anomalies, which are often seen in conjunction with congenital heart defects such as pulmonary atresia and ventricular septal defects (VSD). These anomalies can lead to inadequate blood flow to the lungs, necessitating surgical intervention to improve pulmonary circulation and overall cardiac function.
The unifocalization procedure begins with the surgical approach, which can be either a median sternotomy or a thoracotomy, allowing the surgeon access to the heart. If cardiopulmonary bypass is not utilized, the surgeon proceeds to mobilize the collateral arteries (MAPCAs) by carefully dissecting them free from surrounding tissues at their origins in the aorta or brachiocephalic branches. This mobilization is crucial for ensuring that the collateral arteries can be effectively connected to the pulmonary artery. Next, the intraparenchymal or hilar segment of the pulmonary artery is also mobilized to facilitate the anastomosis. Control of the branch vessels is achieved by placing clamps on the pulmonary artery branches and the collateral arteries. The MAPCAs are then divided from the aorta, and the aortic ends are oversewn to prevent any potential bleeding. Following this, the distal ends of the collateral arteries are attached to the pulmonary artery, creating a new pathway for blood flow. Once the anastomosis is completed, the clamps are released, and additional sutures are placed to control any bleeding at the anastomosis sites. If cardiopulmonary bypass was used during the procedure, the patient is carefully weaned off the bypass support. Finally, chest tubes are placed to facilitate drainage, and the chest incision is closed, completing the surgical intervention.
Post-procedure care involves monitoring the patient for any complications related to the surgery, such as bleeding or infection. The placement of chest tubes is essential for managing any fluid accumulation in the thoracic cavity. Patients are typically observed in a critical care setting for a period following the procedure to ensure stable hemodynamics and adequate respiratory function. Recovery may vary based on the individual patient's condition and the complexity of the surgical intervention, but the unifocalization procedure is generally the first step in a staged approach to correcting multiple cardiac anomalies. Follow-up care will include regular assessments of cardiac function and pulmonary blood flow to evaluate the success of the procedure.
| Short Descr | RPR PUL ART UNIFOCAL W/O CPB | Medium Descr | RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/O BYPASS | Long Descr | Repair of pulmonary artery arborization anomalies by unifocalization; without cardiopulmonary bypass | Status Code | Active Code | Global Days | 090 - Major Surgery | 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 61 - Other OR procedures on vessels other than head and neck |
This is a primary code that can be used with these additional add-on codes.
| 33257 | Addon Code MPFS Status: Active Code APC C Illustration for Code Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), limited (eg, modified maze procedure) (List separately in addition to code for primary procedure) | 33258 | Addon Code MPFS Status: Active Code APC C Illustration for Code Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (eg, maze procedure), without cardiopulmonary bypass (List separately in addition to code for primary procedure) | 33924 | Addon Code MPFS Status: Active Code APC C CPT Assistant Article Ligation and takedown of a systemic-to-pulmonary artery shunt, performed in conjunction with a congenital heart procedure (List separately in addition to code for primary procedure) |
| 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). |
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| 2006-01-01 | Added | First appearance in code book in 2006. |
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