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The CPT® Code 33730 refers to the complete repair of total anomalous pulmonary venous return (TAPVR), which is a congenital heart defect characterized by an abnormal connection of the pulmonary veins. In a normal anatomical configuration, the pulmonary veins should drain oxygenated blood from the lungs into the left atrium of the heart. However, in TAPVR, all four pulmonary veins drain into the right atrium through an abnormal connection, leading to inadequate oxygenation of the blood and various clinical complications. TAPVR is classified into three types based on the location of the abnormal connection: supracardiac, intracardiac, and infracardiac. In supracardiac TAPVR, the pulmonary veins connect to a vertical vein that drains into the innominate vein, which subsequently empties into the superior vena cava and then into the right atrium. Intracardiac TAPVR involves the pulmonary veins draining directly into the right atrium or through the coronary sinus, which is responsible for returning blood from the heart muscle itself back to the right atrium. In infracardiac TAPVR, the pulmonary veins connect to the hepatic veins, which drain into the inferior vena cava before reaching the right atrium. All patients with TAPVR also present with an atrial septal defect (ASD), which is a hole in the wall separating the left and right atria. The surgical procedure to repair TAPVR typically involves accessing the heart through a midline sternotomy or a left anterolateral thoracotomy, establishing cardiopulmonary bypass, and initiating cardioplegic arrest to protect the heart during surgery. The repair process involves severing the abnormal connections and redirecting the pulmonary veins to the left atrium, as well as addressing the associated ASD. This complex procedure is critical for restoring normal blood flow and improving oxygenation in affected patients.
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The complete repair of anomalous pulmonary venous return (CPT® Code 33730) is indicated for patients diagnosed with total anomalous pulmonary venous return (TAPVR). This condition is characterized by the following:
The procedure for the complete repair of TAPVR involves several critical steps, which are detailed as follows:
Post-procedure care following the complete repair of TAPVR involves close monitoring of the patient in a critical care setting. Patients are typically observed for any signs of complications, such as bleeding, infection, or arrhythmias. Recovery may include pain management, respiratory support, and gradual mobilization. The surgical team will also monitor the patient's heart function and oxygenation levels to ensure that the repair is successful. Follow-up appointments are essential to assess the long-term outcomes of the surgery and to manage any potential residual issues related to the heart's structure or function.
| Short Descr | REPAIR HEART-VEIN DEFECT(S) | Medium Descr | COMPLETE RPR ANOMALOUS PULMONARY VENOUS RETURN | Long Descr | Complete repair of anomalous pulmonary venous return (supracardiac, intracardiac, or infracardiac types) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 49 - Other OR heart procedures |
This is a primary code that can be used with these additional add-on codes.
| 33257 | Addon Code MPFS Status: Active Code APC C Illustration for Code Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), limited (eg, modified maze procedure) (List separately in addition to code for primary procedure) | 33259 | Addon Code MPFS Status: Active Code APC C Illustration for Code Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (eg, maze procedure), with cardiopulmonary bypass (List separately in addition to code for primary procedure) | 34714 | Addon Code MPFS Status: Active Code APC N ASC N1 Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition to code for primary procedure) | 34716 | Addon Code MPFS Status: Active Code APC N ASC N1 Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure) | 34833 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open iliac artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by abdominal or retroperitoneal incision, unilateral (List separately in addition to code for primary procedure) |
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| 2007-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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