How To Use CPT Code 33694

CPT 33694 describes the complete repair of tetralogy of Fallot without pulmonary atresia, including the use of a transannular patch. 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 33694?

CPT 33694 is used to describe the complete repair of tetralogy of Fallot without pulmonary atresia. This procedure involves closing off the ventricular septal defect with a patch, removing muscle tissue to restore blood flow through the ventricular outflow tract if necessary, and enlarging the pulmonary anulus with a patch graft to correct narrowing of the pulmonary valve.

2. Official Description

The official description of CPT code 33694 is: ‘Complete repair tetralogy of Fallot without pulmonary atresia; with transannular patch.’

3. Procedure

1. The provider makes an incision in the chest to access the heart, typically through median sternotomy.
2. The patient is placed on cardiopulmonary bypass (CPB) to temporarily take over the function of the heart and lungs.
3. The provider closes the ventricular septal defect with a patch graft, typically made of polytetrafluoroethylene (PTFE).
4. If necessary, the provider removes infundibular muscle to relieve the right ventricular outflow tract obstruction.
5. The provider examines the pulmonary anulus and enlarges it as appropriate for the patient, using incisions and suturing a patch to the pulmonary artery and ventricle incisions.
6. The patient is taken off CPB, the incisions in the heart are closed, and the provider checks for bleeding.
7. Any instruments are removed, and the incision in the chest is closed.

4. Qualifying circumstances

CPT 33694 is performed on patients with tetralogy of Fallot, a congenital heart defect that consists of four heart defects: a ventricular septal defect (VSD), pulmonary stenosis, right ventricular hypertrophy, and the aorta positioned over the VSD. The procedure is performed without pulmonary atresia, which is severe narrowing causing obstruction of the opening where the trunk of the right pulmonary artery enters the right ventricle. The use of a transannular patch is a qualifying circumstance for this code.

5. When to use CPT code 33694

CPT code 33694 should be used when the provider performs a complete repair of tetralogy of Fallot without pulmonary atresia, including the use of a transannular patch. It should not be used for repairs that do not involve these specific elements.

6. Documentation requirements

To support a claim for CPT 33694, the provider must document the following information:

• Patient’s diagnosis of tetralogy of Fallot
• Details of the complete repair procedure, including the use of a transannular patch
• Date of the procedure
• Any additional relevant information, such as the size of the patch graft or any complications encountered
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 33694, ensure that the procedure meets the criteria for a complete repair of tetralogy of Fallot without pulmonary atresia, including the use of a transannular patch. Modifier 63 should not be reported in conjunction with CPT 33694. If a systemic-to-pulmonary artery shunt ligation and takedown is performed in conjunction with the repair, see CPT code 33924 for appropriate coding. It is important to review the specific billing guidelines and requirements of the payer to ensure accurate and appropriate billing.

8. Historical information

CPT 33694 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 complete repair of tetralogy of Fallot without pulmonary atresia, including the use of a transannular patch, on a newborn baby.
2. A surgeon performs a complete repair of tetralogy of Fallot without pulmonary atresia, including the use of a transannular patch, on a 5-year-old child.
3. A cardiac specialist performs a complete repair of tetralogy of Fallot without pulmonary atresia, including the use of a transannular patch, on a teenager.
4. A team of surgeons performs a complete repair of tetralogy of Fallot without pulmonary atresia, including the use of a transannular patch, on an adult patient.
5. A provider performs a complete repair of tetralogy of Fallot without pulmonary atresia, including the use of a transannular patch, on a patient with additional congenital heart defects.
6. A pediatric cardiologist performs a complete repair of tetralogy of Fallot without pulmonary atresia, including the use of a transannular patch, on a patient with a history of previous cardiac surgeries.
7. A cardiothoracic surgeon performs a complete repair of tetralogy of Fallot without pulmonary atresia, including the use of a transannular patch, on a patient with comorbidities.