2025 CPT code 33926
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Repair of pulmonary artery arborization anomalies by unifocalization; with cardiopulmonary bypass.
Modifiers may be applicable depending on the specific circumstances of the procedure (e.g., 51 for multiple procedures, 58 for staged procedures, 78 for unplanned return to the OR).Consult current modifier guidelines for specific applications.
Medical necessity is established by the presence of significant pulmonary artery anomalies that compromise pulmonary blood flow, leading to cyanosis or other symptoms of inadequate oxygenation.The procedure is indicated to improve pulmonary blood flow, optimize cardiac function, and enhance the patient's quality of life.Documentation should demonstrate the severity of the condition and the expected benefits of the procedure.
The surgeon performs the procedure, including incision (thoracotomy or sternotomy), initiation of cardiopulmonary bypass, division and rerouting of MAPCAs, closure of aortic stumps, suturing or ligation of collateral arteries, and closure of the incision.
In simple words: The surgeon fixes problems with the branching of the pulmonary arteries in the lungs, creating a single, unified blood supply to the lungs. This surgery requires a heart-lung machine to keep the blood flowing while the surgeon works.
This procedure involves the repair of pulmonary artery anomalies characterized by abnormal branching (arborization).The surgeon creates a single, unified pulmonary blood supply (unifocalization) using cardiopulmonary bypass. This involves accessing the major aortopulmonary collateral arteries (MAPCAs), dividing them from the aorta and other vessels, closing the aortic stumps, and suturing the collateral arteries to the appropriate pulmonary artery segments, or ligating them to control blood flow.The chest incision (thoracotomy or sternotomy) is then closed.
Example 1: A newborn with pulmonary atresia and ventricular septal defect, presenting with severe cyanosis and abnormal pulmonary artery branching. The surgeon performs unifocalization with cardiopulmonary bypass to create a single pulmonary blood supply and improve oxygenation., An infant with complex congenital heart disease, including pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries. The surgeon uses a staged approach, first performing unifocalization with cardiopulmonary bypass to improve pulmonary blood flow, followed by later intracardiac repair., A child with previous palliative surgery for pulmonary atresia.Subsequent evaluation reveals persistent abnormal pulmonary artery branching and compromised blood flow. The surgeon performs unifocalization with cardiopulmonary bypass to optimize pulmonary arterial circulation.
Detailed preoperative evaluation including echocardiograms, cardiac catheterization, and CT angiography to assess pulmonary artery anatomy and the extent of collateral arteries.Operative report detailing the specific techniques used for unifocalization (e.g., ligation, anastomosis), the number and location of collateral arteries addressed, and the type of closure.Postoperative echocardiograms and other imaging studies to verify successful repair and assess overall cardiac function.Complete anesthesia records, including cardiopulmonary bypass parameters.
** This procedure is complex and requires specialized surgical expertise.The specific techniques used for unifocalization may vary depending on the patient's anatomy and the surgeon's preference.Accurate documentation is crucial for proper coding and reimbursement.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Modifier TC rule: The TC modifier is not typically applicable to this code.
- Fee Schedule: The historical fee schedule data is unavailable.Refer to specific payer fee schedules for historical data.
- Specialties:Cardiothoracic Surgery, Pediatric Cardiology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center