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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.
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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:
The surgical procedure for the repair of pulmonary artery stenosis involves several critical steps, which are detailed as follows:
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 |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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