2025 CPT code 33745
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Initial transcatheter intracardiac shunt creation using stent placement to improve blood flow in congenital heart defects; includes imaging guidance, diagnostic cardiac catheterization (if performed), and target zone angioplasty (if performed).
Modifiers may be applicable depending on the specific circumstances of the procedure. Consult the CPT® guidelines for modifier usage.
Medical necessity is established by the presence of a congenital cardiac anomaly causing hemodynamic compromise that requires intervention to improve blood flow. The specific defect, degree of compromise, and suitability of the TIS procedure should all be documented to support medical necessity.
The clinical responsibility rests primarily with an interventional cardiologist. This includes pre-procedure assessment, patient preparation and monitoring during the procedure, stent placement, angioplasty if necessary, post-procedure care, and interpretation of the results. Other healthcare professionals, including nurses, surgical technicians, and anesthesiologists, may assist in the procedure.
In simple words: This code covers a heart procedure where a tiny tube (catheter) is guided into the heart to place a small mesh tube (stent) to improve blood flow. This is done for babies or children born with heart defects.The procedure uses imaging to guide the catheter and stent, and sometimes other tests (like heart catheterization) may also be part of this procedure.
This code reports the initial creation of a transcatheter intracardiac shunt (TIS) using stent placement to establish effective intracardiac blood flow in patients with congenital cardiac anomalies.The procedure involves percutaneous access, catheter advancement to the heart under imaging guidance (fluoroscopy and ultrasound), stent placement within the target intracardiac location (e.g., atrial septum, Fontan fenestration, right ventricular outflow tract, Mustard/Senning/Warden baffles), and any necessary angioplasty (pre- or post-dilation) within the target lesion. Diagnostic right and left heart catheterization is included when performed; however, additional diagnostic angiography may be separately reported if it's considered a distinct service.Multiple stents placed at a single location are reported only once using this code.Additional shunt creation at separate locations during the same session is reported using add-on code +33746.
Example 1: A newborn with transposition of the great arteries undergoes a transcatheter intracardiac shunt creation by stent placement in the atrial septum to improve oxygenation before definitive surgical repair., An infant with hypoplastic left heart syndrome receives a stent in the right ventricular outflow tract to augment pulmonary blood flow as part of a staged surgical approach., A child with a Fontan circulation develops a significant stenosis at the fenestration site. A stent is deployed during catheterization to improve blood flow through the Fontan pathway.
Detailed preoperative assessment including history, physical examination, and imaging studies (echocardiogram, cardiac catheterization).Intraoperative documentation should specify the exact location of stent placement, details on angioplasty performed (if any), types and number of stents used, imaging guidance used, and hemodynamic data obtained.Postoperative documentation including patient response, complications, and any further interventions.
** Always review the most current CPT® guidelines for accurate coding and billing practices.Documentation must clearly support the medical necessity for the procedure and the specific codes billed.The information provided here is for guidance only and does not constitute medical or legal advice.
- Revenue Code: P2F (Major Procedure, Cardiovascular - Other)
- RVU: This information is not provided in the source text.RVUs vary based on geographic location and other factors. Consult your local fee schedule.
- Global Days: The global period is not explicitly defined in the provided source text. Further information should be obtained from local Medicare guidelines or other relevant payer documentation.
- Payment Status: Active
- Modifier TC rule: The provided text does not specify whether a technical component (TC) modifier applies.Further information should be obtained from local Medicare guidelines or other relevant payer documentation.
- Fee Schedule: Fee schedule information is not provided in the source.Consult local fee schedules and payer guidelines for reimbursement details.
- Specialties:Interventional Cardiology, Pediatric Cardiology, Cardiac Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center