How To Use CPT Code 33736

CPT 33736 describes a specific procedure performed on the heart and pericardium. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 33736?

CPT 33736 is a code used to describe a particular procedure performed on the heart and pericardium. This procedure involves either removing the atrial septum or intentionally creating an opening in the atrial septum, which is the wall of tissue separating the right and left atrium of the heart. It is important to note that this is an open heart surgery, meaning that the patient is placed on cardiopulmonary bypass during the procedure.

2. Official Description

The official description of CPT code 33736 is: ‘Atrial septectomy or septostomy; open heart with cardiopulmonary bypass.’

3. Procedure

1. The provider begins by making an incision in the chest wall to access the heart. This is typically done through a median sternotomy incision, which involves cutting the sternum (breastbone) in the middle to open the chest.
2. Once the chest is open, the provider places the patient on cardiopulmonary bypass, which temporarily takes over the function of the heart and lungs.
3. The provider then occludes portions of the left and right atria with a clamp and may also occlude the pulmonary veins if necessary.
4. Next, the provider makes incisions in both the left and right atria to access and either excise the atrial septum or create a hole in it.
5. After completing the necessary steps, the provider stops any bleeding and gradually weans the patient off of cardiopulmonary bypass.
6. Finally, the provider closes the incisions made during the procedure, suturing the layers of tissue together. Chest or drainage tubes may be placed before dressing the chest incision.

4. Qualifying circumstances

CPT 33736 is performed on patients who require alteration of the flow of oxygenated blood in the treatment of transposition of the great vessels (TGV), a congenital anomaly where major blood vessels of the heart are abnormally arranged or attached. It is important to note that this procedure is typically no longer performed, as advancements in medical techniques have led to alternative treatments for TGV.

5. When to use CPT code 33736

CPT code 33736 should be used when the provider performs an open heart procedure with cardiopulmonary bypass to either remove the atrial septum or create an opening in it. It is important to note that this code should not be used for closed heart surgeries or procedures that do not involve cardiopulmonary bypass.

6. Documentation requirements

To support a claim for CPT 33736, the provider must document the following information:

• Patient’s diagnosis and the medical necessity for the procedure
• Details of the procedure performed, including the specific steps taken
• Date of the procedure
• Start and end time of the procedure
• Any complications or unexpected findings during the procedure
• Details of the closure of incisions and any additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 33736, it is important to ensure that the procedure was performed as an open heart surgery with cardiopulmonary bypass. This code should not be reported with modifier 63 or in conjunction with CPT codes 33735 or 33737. It is also important to note that CPT 33736 is listed under the Inpatient Only (IPO) list for Medicare, meaning it is typically only performed in an inpatient setting.

8. Historical information

CPT 33736 was added to the Current Procedural Terminology system on January 1, 1994. There have been no updates to the code since its addition. It is important to note that this procedure is no longer commonly performed due to advancements in medical techniques.

9. Examples

1. A patient with transposition of the great vessels (TGV) undergoes an open heart procedure with cardiopulmonary bypass to create an opening in the atrial septum.
2. A provider performs an atrial septectomy during an open heart surgery to treat a patient with a congenital heart defect.
3. An infant with a complex heart condition requires an atrial septostomy to improve blood flow.
4. A patient with a history of heart disease undergoes an atrial septectomy to alleviate symptoms and improve cardiac function.
5. A provider performs an atrial septostomy on a patient with pulmonary hypertension to relieve pressure in the heart.
6. An adult patient with a congenital heart defect undergoes an open heart procedure with cardiopulmonary bypass to remove the atrial septum.
7. A provider performs an atrial septectomy during an open heart surgery to correct a structural abnormality in the heart.
8. A child with a complex heart condition requires an atrial septostomy to improve oxygenation and circulation.
9. A patient with a history of heart failure undergoes an atrial septectomy to improve cardiac function and quality of life.
10. A provider performs an atrial septostomy on a patient with a rare heart condition to improve blood flow and oxygenation.