How To Use CPT Code 33478

CPT 33478 describes the procedure known as outflow tract augmentation, which involves the placement of a graft to enlarge the ventricular outflow tract. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 33478?

CPT 33478 is used to describe the surgical procedure known as outflow tract augmentation. This procedure involves the placement of a graft to enlarge the ventricular outflow tract. The provider may also perform a commissurotomy or infundibular resection if necessary. This procedure is typically performed to relieve obstruction of the ventricular outflow tract, and it is commonly used in cases of pulmonary atresia.

2. Official Description

The official description of CPT code 33478 is: ‘Outflow tract augmentation (gusset), with or without commissurotomy or infundibular resection.’ It is important to note that when a cavopulmonary anastomosis to a second superior vena cava is performed in conjunction with this procedure, CPT code 33478 should be used along with CPT code 33768.

3. Procedure

1. During the procedure, the provider makes an incision to access the heart, typically through a median sternotomy.
2. The provider then makes an incision in the infundibulum, which is the cone-shaped portion of the right ventricle near the entrance to the pulmonary trunk.
3. Using a patch graft, which can be an allograft, synthetic graft, or the patient’s own tissue, the provider enlarges the opening in the infundibulum.
4. If necessary, the provider may also incise the junctions of the valve leaflets or remove thickened muscular tissue from the infundibulum.
5. After completing the necessary modifications, the provider closes the incisions in the heart structures and checks for any bleeding.
6. Finally, the provider closes the incision in the chest.

4. Qualifying circumstances

CPT 33478 is typically performed on patients with pulmonary atresia, a condition characterized by severe narrowing or absence of the opening of the right pulmonary artery into the right ventricle. This procedure is indicated when there is obstruction of blood flow out of the ventricle. The provider must assess the patient’s condition and determine the need for outflow tract augmentation. The procedure is performed by a qualified healthcare professional who has the necessary expertise and training in cardiac surgery.

5. When to use CPT code 33478

CPT code 33478 should be used when the provider performs the outflow tract augmentation procedure, which involves the placement of a graft to enlarge the ventricular outflow tract. It is important to note that this code should be used in conjunction with CPT code 33768 when a cavopulmonary anastomosis to a second superior vena cava is also performed.

6. Documentation requirements

To support a claim for CPT code 33478, the provider must document the following information:

• Indication for the procedure, such as pulmonary atresia
• Details of the procedure performed, including any additional procedures like commissurotomy or infundibular resection
• Type of graft used for the outflow tract augmentation
• Date of the procedure
• Any complications or unexpected findings
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 33478, ensure that the procedure meets the criteria for this code. It is important to use the appropriate CPT code based on the specific procedure performed. If a cavopulmonary anastomosis to a second superior vena cava is also performed, CPT code 33768 should be reported in addition to CPT code 33478. It is important to follow the specific guidelines provided by the payer and to include all necessary documentation to support the claim.

8. Historical information

CPT code 33478 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition. It is important to stay updated with any changes or revisions to the code in order to accurately report the procedure.

9. Examples

1. A patient with pulmonary atresia undergoes outflow tract augmentation to relieve obstruction of the ventricular outflow tract.
2. A provider performs outflow tract augmentation with commissurotomy for a patient with severe narrowing of the pulmonary artery.
3. An infant with congenital heart disease undergoes outflow tract augmentation to improve blood flow from the right ventricle to the pulmonary artery.
4. A patient with a history of pulmonary atresia and previous surgical interventions undergoes outflow tract augmentation to address recurrent obstruction.
5. A provider performs outflow tract augmentation with infundibular resection for a patient with thickened muscular tissue in the infundibulum.
6. A child with complex congenital heart disease undergoes outflow tract augmentation as part of a staged surgical approach.
7. An adult patient with pulmonary atresia and associated cardiac anomalies undergoes outflow tract augmentation to improve overall cardiac function.
8. A provider performs outflow tract augmentation using the patient’s own tissue for a patient with a history of graft rejection.
9. A teenager with pulmonary atresia and significant symptoms undergoes outflow tract augmentation to improve quality of life.
10. An elderly patient with pulmonary atresia undergoes outflow tract augmentation to address worsening symptoms and complications.