Summary & Overview
CPT 33478: Ventricular Outflow Tract Enlargement with Graft
CPT code 33478 represents a cardiac surgical procedure that places a graft to enlarge the ventricular outflow tract, with potential incision of valve leaflets or removal of obstructing muscular tissue from the infundibulum. It is used to relieve obstruction of the ventricular outflow tract and is indicated in congenital conditions such as pulmonary atresia. This procedure is clinically significant because it addresses life-threatening obstruction of blood flow from the ventricle, often necessitating inpatient cardiac surgical care.
Key payers considered include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise outline of clinical context, typical settings of care, and payer coverage landscape. The publication provides benchmarks and coding context useful for billing, revenue cycle, and clinical teams, as well as a summary of common modifiers used with this code. Policy and reimbursement updates are summarized to inform billing practices and payer negotiations.
This national-level summary is intended for hospital administrators, cardiac surgeons, coding professionals, and revenue-cycle specialists seeking a clear reference on the clinical purpose and billing context of CPT code 33478 and what to expect across major commercial payers and Medicare.
Billing Code Overview
CPT code 33478 describes a surgical procedure in which the provider places a graft to enlarge the ventricular outflow tract. The operation may include incision of the valve leaflet junctions or excision of thickened muscular tissue from the infundibulum to relieve obstruction of the ventricular outflow tract. Indications include congenital lesions such as pulmonary atresia.
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Service type: Cardiac surgical procedure to relieve right ventricular outflow tract obstruction (outflow tract reconstruction/enlargement)
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Typical site of service: Inpatient operating room or cardiac surgical suite; procedure is performed during open cardiac surgery under general anesthesia
Clinical & Coding Specifications
Clinical Context
A typical patient is an infant or child presenting with cyanosis, exertional intolerance, and signs of right ventricular outflow tract (RVOT) obstruction due to congenital pulmonary valve and infundibular anomalies such as severe pulmonary stenosis, pulmonary atresia with ventricular septal defect, or tetralogy of Fallot with significant RVOT narrowing. The clinical workflow begins with initial evaluation in pediatric cardiology with history, physical exam, pulse oximetry, chest radiography, and transthoracic echocardiography demonstrating RVOT obstruction. Cardiac catheterization and cross-sectional imaging (CT or MRI) may be performed preoperatively for anatomic definition and surgical planning. The patient is scheduled for open cardiac surgery in an operating room or cardiac surgical suite (typical site of service: inpatient hospital operating room or cardiac surgery center). Intraoperative transesophageal echocardiography is commonly used for real-time assessment. The surgeon performs RVOT enlargement by placing a patch graft to enlarge the ventricular outflow tract, and if necessary incises fused valve leaflets or excises hypertrophied infundibular muscle to relieve obstruction. Postoperative care occurs in the pediatric or cardiothoracic intensive care unit with hemodynamic monitoring, ventilatory support as needed, pain control, and serial echocardiography to assess repair. Typical payors for authorization and claims include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) |