Summary & Overview
CPT 33474: Pulmonary Valve Incision (Valvotomy) on Cardiopulmonary Bypass
CPT code 33474 denotes a pulmonary valve incision (valvotomy/valvuloplasty) performed with the patient on cardiopulmonary bypass to relieve pulmonary valve stenosis. This cardiac surgical procedure is clinically significant for patients with obstructive lesions of the pulmonary valve that impair right ventricular outflow and can be performed as part of corrective congenital or acquired valve interventions. Nationally, the code matters because it captures a specialized operative intervention that influences surgical quality reporting, inpatient resource use, and cardiac surgical case mix.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for the procedure, typical sites of service, and the scope of care this code represents. The publication outlines the practical billing considerations tied to inpatient cardiac surgery and highlights where 33474 fits into surgical coding workflows. It also provides benchmarks and policy context where available, and notes when input data are not provided. The goal is to help billing, coding, and clinical teams understand the code’s clinical intent and operational setting, and to point to areas where further payer-specific coverage or documentation guidance may be needed.
Billing Code Overview
CPT code 33474 describes a surgical procedure to relieve pulmonary valve stenosis while the patient is on cardiopulmonary bypass. The provider accesses the pulmonary valve through the pulmonary artery and incises the valve leaflets (cusps) to enlarge the valve opening and correct obstruction.
-
Service type: Surgical cardiac procedure (valvotomy/valvuloplasty of the pulmonary valve)
-
Typical site of service: Inpatient operating room or cardiac surgery suite with cardiopulmonary bypass capability
Clinical & Coding Specifications
Clinical Context
A typical patient is an adolescent or adult with symptomatic or hemodynamically significant pulmonary valve stenosis, frequently presenting with exertional dyspnea, fatigue, chest pain, syncope, or right ventricular hypertrophy on imaging. Preoperative evaluation includes transthoracic and/or transesophageal echocardiography documenting pulmonary valve gradient and anatomy, cardiac catheterization as needed for hemodynamics, routine labs, and anesthesia assessment. The procedure 33474 (pulmonary valvotomy with cardiopulmonary bypass) is performed in an operating room with cardiothoracic surgical teams and perfusion support when the valve lesion is not amenable to percutaneous balloon valvuloplasty or when concomitant intracardiac repairs are required.
The workflow: preoperative consent and imaging review, general endotracheal anesthesia, median sternotomy or appropriate surgical exposure, institution of cardiopulmonary bypass, cardioplegic arrest as indicated, direct opening of the pulmonary artery, incision of valve leaflets/cusps to enlarge the valve orifice, assessment of valve competence, any additional repairs (e.g., RV outflow tract reconstruction) as indicated, weaning from bypass, hemostasis, chest closure, and postoperative ICU monitoring with serial echocardiography and hemodynamic management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | When two surgeons work together as primary operating surgeons for shared critical portions of the procedure. |