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Official Description

Repair of pulmonary artery stenosis by reconstruction with patch or graft

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Pulmonary artery stenosis refers to the narrowing of the pulmonary artery, which can occur in the main pulmonary artery or in the branches that lead to the right or left lungs. This condition can impede blood flow from the heart to the lungs, potentially leading to various cardiovascular complications. The surgical procedure described by CPT® Code 33917 involves a repair of this stenosis through reconstruction using a patch or graft. The operation is performed with the patient under general anesthesia, and access to the heart is achieved via a median sternotomy, which involves making an incision along the sternum to expose the heart and surrounding structures. During the procedure, the pericardium, which is the fibrous sac surrounding the heart, is incised to allow for the harvesting of a patch of pericardium that will be used later as a graft. The surgical team meticulously dissects the main pulmonary artery and its branches from the surrounding tissues to gain access to the narrowed areas. To control blood flow during the repair, rubber loops are placed around the arteries to gently occlude them. The narrowed segment of the pulmonary artery is then incised longitudinally, and a patch or graft—made from autologous pericardium, an allograft (homograft), a xenograft, or synthetic material—is inserted to enlarge the narrowed section, thereby restoring adequate blood flow. After the reconstruction, chest tubes may be placed to facilitate drainage, and the chest incision is subsequently closed to complete the procedure.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 33917 is indicated for patients diagnosed with pulmonary artery stenosis. This condition may present with various symptoms or complications, which can include:

  • Narrowing of the pulmonary artery - This is the primary condition that necessitates the surgical intervention.
  • Impaired blood flow to the lungs - Resulting from the stenosis, this can lead to decreased oxygenation of blood.
  • Symptoms of heart failure - Patients may exhibit signs such as fatigue, shortness of breath, or exercise intolerance due to the heart's increased workload.
  • Congenital heart defects - In some cases, pulmonary artery stenosis may be associated with other congenital anomalies that require surgical correction.

2. Procedure

The surgical procedure for the repair of pulmonary artery stenosis involves several critical steps, which are detailed as follows:

  • Step 1: Median Sternotomy - The procedure begins with a median sternotomy, where an incision is made along the sternum to provide access to the heart and surrounding structures. This approach allows the surgeon to visualize and operate on the pulmonary arteries effectively.
  • Step 2: Incision of the Pericardium - Once access is achieved, the pericardium, the protective sac surrounding the heart, is incised. This step is essential for exposing the heart and for harvesting a patch of pericardium that will be used later in the procedure.
  • Step 3: Dissection of the Pulmonary Arteries - The main pulmonary artery, along with the right and left pulmonary arteries, is carefully dissected free from surrounding tissues. This dissection is crucial to gain access to the narrowed segments of the arteries that require repair.
  • Step 4: Placement of Rubber Loops - To control blood flow during the repair, rubber loops are placed around the pulmonary arteries. These loops gently occlude the vessels, allowing the surgeon to work on the arteries without significant blood loss.
  • Step 5: Incision of the Narrowed Section - The narrowed section of the pulmonary artery is incised longitudinally. This incision is necessary to prepare the area for the insertion of the graft or patch.
  • Step 6: Insertion of Patch or Graft - A patch or graft is then inserted into the incised area to enlarge the narrowed section of the artery. The graft may be made from autologous pericardium, an allograft (homograft), a xenograft, or synthetic material, depending on the specific requirements of the case.
  • Step 7: Placement of Chest Tubes - After the reconstruction is complete, chest tubes may be placed as needed to facilitate drainage of any fluid that may accumulate in the chest cavity post-operatively.
  • Step 8: Closure of the Chest Incision - Finally, the chest incision is closed, completing the surgical procedure. The closure is performed in layers to ensure proper healing and stability of the chest wall.

3. Post-Procedure

Post-procedure care following the repair of pulmonary artery stenosis includes monitoring the patient for any complications, such as bleeding or infection. Patients may require pain management and will be observed in a recovery area until they are stable. The presence of chest tubes will be monitored, and they will be removed once the drainage is deemed adequate. Follow-up imaging may be necessary to assess the success of the repair and ensure that blood flow through the pulmonary arteries is restored. Patients will also receive instructions regarding activity restrictions and signs of potential complications to watch for during their recovery period.

Short Descr REPAIR PULMONARY ARTERY
Medium Descr RPR PULMONARY ART STENOSIS RCNSTJ W/PATCH/GRAFT
Long Descr Repair of pulmonary artery stenosis by reconstruction with patch or graft
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 61 - Other OR procedures on vessels other than head and neck

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)
33924 Addon Code MPFS Status: Active Code APC C CPT Assistant Article Ligation and takedown of a systemic-to-pulmonary artery shunt, performed in conjunction with a congenital heart procedure (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)
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC This service has been performed in part by a resident under the direction of a teaching physician
Date
Action
Notes
1994-01-01 Added First appearance in code book in 1994.
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