2025 CPT code 33925
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Feed
Repair of pulmonary artery arborization anomalies by unifocalization; without cardiopulmonary bypass.
Modifiers may be applicable to this code.Commonly used modifiers with 33925 include 22 (Increased Procedural Services), 51 (Multiple Procedures), 59 (Distinct Procedural Service), 62 (Two Surgeons), and 80 (Assistant Surgeon). The appropriate modifier should be appended to the code to reflect the specific circumstances of the procedure.
Medical necessity for this procedure is established by the presence of pulmonary atresia, VSD, and/or major aortopulmonary collateral arteries causing significant compromise of pulmonary blood flow. The procedure aims to improve oxygenation, reduce pulmonary hypertension, and prepare the patient for a complete repair if necessary. Documentation must clearly demonstrate the severity of the anomaly and the impact on the patient's health.
The surgeon is responsible for performing the entire procedure, from the initial incision to the final closure. This includes identifying and dissecting the MAPCAs, closing the openings in the aorta, suturing the collateral arteries to the pulmonary artery segments, and managing any complications that may arise during the surgery.
In simple words: This procedure corrects abnormal blood vessel connections in the lungs of babies born with improperly developed pulmonary arteries. The surgeon reroutes the blood vessels to establish a normal blood supply to the lungs. This surgery is performed without using a heart-lung machine.
This procedure involves the repair of pulmonary arteries and the creation of a single source of pulmonary blood supply (unifocalization) to correct branching abnormalities (arborization anomalies). This is performed without the use of a heart-lung machine (cardiopulmonary bypass).The surgeon opens the chest, either through a sternotomy (incision along the breastbone) or a thoracotomy (incision into the chest wall). The major aortopulmonary collateral arteries (MAPCAs), which are abnormal vessels supplying blood to the lungs, are identified and disconnected from the aorta and other connected vessels. The ends of these vessels attached to the aorta are closed. The surgeon then connects the free ends of the collateral arteries to the appropriate segments of the pulmonary artery, redirecting blood flow to the correct location. Alternatively, the surgeon might tie off (ligate) the side branches at their origin to control blood flow. Both methods achieve the goal of routing blood flow into a single vessel or directly into the pulmonary artery. Finally, the incision is closed with sutures.
Example 1: A newborn is diagnosed with pulmonary atresia, VSD, and major aortopulmonary collateral arteries. Unifocalization without cardiopulmonary bypass is performed to correct the abnormal blood vessel connections and establish a single source of pulmonary blood flow., An infant with complex congenital heart disease involving abnormal pulmonary artery branching undergoes unifocalization to redirect blood flow to the appropriate lung segments and improve oxygenation., A child with pulmonary atresia and underdeveloped pulmonary arteries requires staged unifocalization to prepare for a later complete repair. This procedure helps to promote the growth of the native pulmonary arteries.
Operative report detailing the surgical approach (sternotomy or thoracotomy), identification and management of the MAPCAs, method of unifocalization, and any intraoperative complications. Preoperative imaging studies (e.g., echocardiogram, CT scan) demonstrating the anatomy of the pulmonary arteries and MAPCAs. Postoperative imaging studies confirming the success of the unifocalization.
- Revenue Code: P1G - Major Procedure - Other
- Specialties:Cardiothoracic Surgery, Pediatric Cardiology, Congenital Cardiac Surgery
- Place of Service:Inpatient Hospital