CPT® Code 33900

Percutaneous pulmonary artery revascularization by stent placement, identified by CPT® Code 33900, is a minimally invasive procedure aimed at treating stenotic lesions within the pulmonary artery. These lesions may not respond adequately to balloon angioplasty alone, necessitating the use of endovascular stents. Stents serve as a supportive structure, providing rigidity to the affected vessel and facilitating improved blood flow. The procedure is performed under general anesthesia and is guided by fluoroscopic imaging, which allows for real-time visualization of the vascular structures. Typically, this intervention is conducted during a cardiac catheterization procedure that is separately reportable, specifically targeting congenital defects in the right and/or left heart. Access to the vascular system is usually achieved through a large vein, although the specific access site may vary based on individual patient anatomy. Prior to the procedure, local anesthesia, such as lidocaine, is administered to the access site to minimize discomfort. The procedure involves puncturing the vein, followed by the placement of a guidewire and introducer sheath. A catheter is then advanced over the guidewire to reach the targeted area of the pulmonary artery. Initial diagnostic angiograms are performed to assess the severity of the stenosis and the dimensions of adjacent vessels, which are critical for selecting the appropriately sized stent and balloon for the intervention. The procedural steps include the exchange of the angiogram catheter for an end-hole catheter, which is equipped with a soft guidewire that is advanced just beyond the stenotic lesion. This soft guidewire is subsequently replaced with a stiffer, interventional guidewire to facilitate the delivery of the stent. The stent is prepared and mounted onto a delivery balloon, and the introducer sheath is exchanged for a delivery sheath that is navigated to the lesion site. Once the stent is positioned correctly across the lesion, the delivery sheath is partially withdrawn to verify the stent's placement through angiography. Adjustments are made as necessary to ensure optimal positioning before the stent is deployed by inflating the delivery balloon. Following deployment, a larger pressure balloon may be used to further dilate the stent to the desired diameter. The procedure concludes with the removal of instruments and ensuring hemostasis at the access site. This code specifically applies to unilateral stent placement through normal native connections in the pulmonary artery.