2025 CPT code 33746
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Creation of each additional intracardiac shunt by stent placement at a separate location during the same session as the primary intervention (33745).
Modifiers may be applicable depending on the circumstances of the procedure. Consult the CPT manual for guidance on modifier usage.
Medical necessity is established by the presence of significant hemodynamic compromise due to congenital heart defects that can be improved with the creation of additional intracardiac shunts.The decision to create additional shunts is typically based on real-time hemodynamic measurements and imaging guidance obtained during the procedure.
The clinical responsibility involves the creation of an additional intracardiac shunt using stent placement in a separate location during the same session as the primary procedure (33745). This may also include left and right heart diagnostic cardiac catheterization, target zone angioplasty, and imaging guidance.
In simple words: This code is for adding another shunt to the heart during the same operation where the doctor already created a first shunt using a catheter.A shunt is a path to help blood flow better.This might involve placing more stents in different spots in the heart and includes imaging guidance and other tests if needed.
This CPT code, 33746, reports the creation of each additional intracardiac shunt using stent placement at a distinct location during the same session as the primary procedure (33745).It includes all balloon angioplasties performed in the target lesion, encompassing pre-dilation, post-dilation, or adjustments using balloons of varying sizes to achieve the therapeutic outcome.The procedure also incorporates imaging guidance (ultrasound and fluoroscopy), and when performed, left and right heart diagnostic cardiac catheterization and target zone angioplasty.This code should only be used in conjunction with 33745, and multiple stents placed in a single location are reported with a single code 33745.Diagnostic cardiac catheterization codes (93451-93461, 93593-93597) should not be used with 33745 or 33746 to report fluoroscopic guidance or limited hemodynamic data solely for the intervention.
Example 1: A neonate with complex congenital heart disease requiring multiple shunt placements for improved circulatory function undergoes a procedure involving initial stent placement (33745) followed by an additional shunt placement at a different location (33746)., A child with a Fontan circulation requires fenestration creation with stent placement (33745). During the same procedure, the surgeon identifies a need for additional shunt placement at another location for optimal blood flow (33746)., An infant with a complex congenital heart defect requires creation of an initial shunt (33745) and, during the same session, requires an additional shunt at a different location to manage circulatory issues (33746). Diagnostic catheterization is also performed during the session.
Comprehensive documentation should include the indication for the procedure, including the preoperative assessment of hemodynamics, imaging studies (echocardiography, cardiac catheterization), and the intraoperative findings.Detailed description of the location and number of stents deployed at each site, use of angioplasty, and the immediate post-operative hemodynamic status must be documented. Any complications must be documented.
** This code is for additional shunt creation only and must be used in conjunction with 33745.The description of the procedure should clearly delineate each additional shunt location.This code does not include the initial shunt creation.
- Revenue Code: P2F (MAJOR PROCEDURE, CARDIOVASCULAR - OTHER)
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Cardiology, Cardiac Surgery, Pediatric Cardiology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center