2025 CPT code 33478
(Active) Effective Date: N/A Revision Date: N/A Cardiovascular Surgery - Surgical Procedures on the Pulmonary Valve Surgery Feed
Outflow tract augmentation (gusset), with or without commissurotomy or infundibular resection.
Modifiers 51 (multiple procedures) and 78 (unplanned return) may be applicable depending on the circumstances.
Medical necessity is established by the presence of significant right ventricular outflow tract obstruction, documented by echocardiography or cardiac catheterization, leading to hemodynamic compromise.The procedure is aimed at improving blood flow and reducing symptoms.
The surgeon performs a median sternotomy, incises the infundibulum, places a patch graft to enlarge the ventricular outflow tract, performs commissurotomy or infundibular resection if necessary, and closes the incisions.Postoperative care is also a part of the clinical responsibility.
In simple words: The doctor enlarges a narrowed area in the heart (the outflow tract) by adding a patch.They may also need to cut or remove some tissue to improve blood flow. This helps the heart pump blood more efficiently.
This procedure involves augmenting the ventricular outflow tract by placing a patch graft to relieve obstruction.This may include commissurotomy (incision of valve leaflets) or infundibular resection (excision of part of the right ventricle) as needed.The approach typically involves a median sternotomy, incision of the infundibulum, placement of the graft (allograft, synthetic, or autologous), closure of incisions, and hemostasis.The procedure is indicated for conditions such as pulmonary atresia.
Example 1: A newborn with pulmonary atresia undergoes outflow tract augmentation with a pericardial patch.Commissurotomy was not needed., A child with tetralogy of Fallot undergoes outflow tract augmentation with a bovine pericardial patch and infundibular resection., An adult with right ventricular outflow tract obstruction due to previous surgery requires outflow tract augmentation with an autologous pericardial patch.
Preoperative echocardiogram, intraoperative images showing graft placement and size, postoperative echocardiogram to assess blood flow, operative report detailing the procedure, and any additional imaging done.
** The type of graft material used should be documented.The specific techniques used (e.g., type of anastomosis) may influence the documentation.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Cardiothoracic Surgery, Cardiac Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center