How To Use CPT Code 33645

CPT 33645 describes the closure of a sinus venosus defect directly or with a patch in a patient with or without anomalous pulmonary venous drainage. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 33645?

CPT 33645 can be used to describe the closure of a sinus venosus defect directly or with a patch in a patient with or without anomalous pulmonary venous drainage. This code is used when the provider performs a surgical procedure to close the defect, either by directly suturing the defect or by using a patch made from the patient’s own pericardium.

2. Official Description

The official description of CPT code 33645 is: ‘Direct or patch closure, sinus venosus, with or without anomalous pulmonary venous drainage.’

3. Procedure

1. The provider begins by making an incision in the midline of the chest and dissecting down to the heart.
2. They then open the atrium and start a suture line between the orifice of the right superior pulmonary vein and the orifice of the superior vena cava.
3. After completing the sutures in the superior location, they carry the suture line along the remaining orifice of the atrial septal defect (ASD).
4. If necessary, they may employ a “two-patch technique” to prevent superior vena cava stenosis, placing a second pericardial patch on the superior vena cava.
5. If the patient also has anomalous pulmonary venous drainage, the provider repairs that defect as well.
6. Finally, they close the atrium and the skin incision to complete the surgery.

4. Qualifying circumstances

Patients eligible to receive CPT 33645 are those with a sinus venosus atrial septal defect (SVASD) located at the junction between the superior vena cava and the right atrium. The goal of the procedure is to eliminate the intracardiac shunt without causing stenosis or obstruction of the pulmonary veins, right ventricle, or superior vena cava.

5. When to use CPT code 33645

CPT code 33645 should be used when the provider performs a direct or patch closure of a sinus venosus defect in a patient with or without anomalous pulmonary venous drainage. It should not be reported in conjunction with CPT codes 33724 or 33726.

6. Documentation requirements

To support a claim for CPT 33645, the provider must document the following information:

• Patient’s diagnosis of sinus venosus atrial septal defect
• Details of the closure procedure, including whether it was performed directly or with a patch
• Any additional repairs performed, such as for anomalous pulmonary venous drainage
• Date of the procedure
• Signature of the provider

7. Billing guidelines

When billing for CPT 33645, ensure that the procedure meets the criteria for closure of a sinus venosus defect. Do not report CPT 33645 in conjunction with CPT codes 33724 or 33726. It is important to review the documentation and choose the correct code from the range of repair procedures for septal defects (33641-33697).

8. Historical information

CPT 33645 was added to the Current Procedural Terminology system on January 1, 1990. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A provider performs a direct closure of a sinus venosus defect in a patient without anomalous pulmonary venous drainage.
2. A provider uses a pericardial patch to close a sinus venosus defect in a patient with anomalous pulmonary venous drainage.
3. A provider repairs a sinus venosus defect and an associated anomalous pulmonary venous drainage in a single procedure.
4. A provider performs a direct closure of a sinus venosus defect and uses a second pericardial patch on the superior vena cava to prevent stenosis.
5. A provider closes a sinus venosus defect and performs additional repairs on the pulmonary veins to ensure proper venous connection.