How To Use CPT Code 33684

CPT 33684 describes the closure of a single ventricular septal defect, with or without patch, along with pulmonary valvotomy or infundibular resection. 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 33684?

CPT 33684 can be used to describe the closure of a single ventricular septal defect, with or without patch, along with pulmonary valvotomy or infundibular resection. This procedure is performed to prevent the mixing of oxygenated and deoxygenated blood by closing the hole in the septum between the ventricles. The provider may also incise the pulmonary valve leaflets and remove any obstructions in the ventricular outflow tract.

2. Official Description

The official description of CPT code 33684 is: ‘Closure of single ventricular septal defect, with or without patch; with pulmonary valvotomy or infundibular resection (acyanotic)’. This code specifically refers to the closure of a single ventricular septal defect, along with additional procedures such as pulmonary valvotomy or infundibular resection.

3. Procedure

1. The provider makes an incision in the chest to access the heart.
2. The patient is placed on cardiopulmonary bypass (CPB) to temporarily take over the function of the heart and lungs.
3. The provider opens the heart through the pulmonary artery or right ventricle.
4. The ventricular septal defect is examined, and the provider determines the approach (atrial or ventricular).
5. The defect is closed using a patch or sutures.
6. The provider incises the pulmonary valve leaflets at their junction and removes any obstructions in the ventricular outflow tract caused by infundibular muscle.
7. The patient is taken off CPB, and the incisions in the heart are closed.
8. The provider checks for bleeding, removes any instruments, and finally closes the incision in the chest.

4. Qualifying circumstances

CPT 33684 is performed on patients with a ventricular septal defect that requires closure. The procedure is typically performed on patients who are acyanotic, meaning they do not exhibit a bluish tint associated with deoxygenated blood. The provider must assess the patient’s condition and determine the need for closure of the ventricular septal defect, along with any additional procedures such as pulmonary valvotomy or infundibular resection.

5. When to use CPT code 33684

CPT code 33684 should be used when the provider performs the closure of a single ventricular septal defect, with or without patch, along with pulmonary valvotomy or infundibular resection. This code is appropriate for patients who require this specific combination of procedures. It should not be used for other types of septal defect closures or procedures.

6. Documentation requirements

To support a claim for CPT 33684, the provider must document the following information:

• Patient’s diagnosis and the need for closure of the ventricular septal defect
• Details of the procedure performed, including whether a patch was used and if pulmonary valvotomy or infundibular resection was performed
• Date of the procedure
• Any complications or unexpected findings during the procedure
• Details of the closure technique used
• Any additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 33684, ensure that the closure of a single ventricular septal defect, along with pulmonary valvotomy or infundibular resection, is performed. Use the appropriate CPT code based on the specific procedures performed. It is important to follow the guidelines provided by the payer and accurately document the procedure to support the claim.

8. Historical information

CPT 33684 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition. However, it is worth noting that Medicare added this procedure to the Inpatient Only (IPO) list in 2017, indicating that it is typically performed on an inpatient basis.

9. Examples

1. A provider performs the closure of a single ventricular septal defect, with a patch, along with pulmonary valvotomy for a patient with acyanotic heart disease.
2. A patient undergoes the closure of a single ventricular septal defect, without a patch, along with infundibular resection to improve blood flow through the ventricular outflow tract.
3. A provider performs the closure of a single ventricular septal defect, with a patch, along with both pulmonary valvotomy and infundibular resection for a patient with acyanotic heart disease.
4. A patient undergoes the closure of a single ventricular septal defect, without a patch, along with pulmonary valvotomy to improve blood flow from the right ventricle to the pulmonary artery.
5. A provider performs the closure of a single ventricular septal defect, with a patch, along with infundibular resection to remove obstructions in the ventricular outflow tract.
6. A patient undergoes the closure of a single ventricular septal defect, without a patch, along with both pulmonary valvotomy and infundibular resection to improve blood flow through the heart.