Summary & Overview
CPT 33610: Ventricular Septal Defect Enlargement with Valved Device
CPT code 33610 denotes an open cardiothoracic surgical repair to enlarge a ventricular septal defect and place a valved device to regulate ventricular outflow. This invasive corrective procedure addresses congenital or persistent VSDs that cause obstruction of blood flow through the ventricular outlet and often requires specialized surgical teams, cardiopulmonary bypass, and postoperative intensive care. Nationally, procedures coded with 33610 have implications for surgical capacity, specialized resource allocation, and complex case-level reimbursement.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage considerations, common billing and coding contexts, clinical indications and care settings, and where benchmarks typically apply for high-acuity cardiac surgical services.
Readers will learn the clinical context of the service, the typical site of service and resource needs, common modifiers used in billing workflows (listed separately), and which payer types commonly reimburse for high-complexity cardiothoracic procedures. The piece also summarizes expected documentation elements and coding considerations relevant to hospital billing teams and revenue cycle stakeholders. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 33610 describes a surgical procedure to enlarge a ventricular septal defect (VSD) by placing a valved device to regulate ventricular outflow and correct obstruction of the ventricular outlet. The service involves open cardiac surgery on the heart to repair an abnormal opening in the wall between the left and right ventricles that failed to close at birth or soon after.
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Service type: Surgical cardiac repair (open ventricular septal defect enlargement with valved device placement)
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Typical site of service: Inpatient hospital setting, operating room with cardiothoracic surgery capabilities and postoperative intensive care unit care
Clinical & Coding Specifications
Clinical Context
A 6-month-old infant with a hemodynamically significant ventricular septal defect (VSD) presents with failure to thrive, recurrent lower respiratory tract infections, and signs of congestive heart failure despite medical management. Echocardiography demonstrates a restrictive VSD with left-to-right shunt and obstruction at the ventricular outflow tract that requires surgical enlargement of the defect and placement of a valved conduit/device to regulate ventricular outflow. The patient is scheduled for open-heart surgery with cardiopulmonary bypass in a tertiary pediatric cardiac center. Preoperative workflow includes cardiology evaluation, anesthesia assessment, crossmatch and blood product preparation, and informed consent. Intraoperative workflow includes median sternotomy, cardiopulmonary bypass, identification and enlargement of the VSD, placement and securing of a valved device to correct outflow restriction, intraoperative transesophageal echocardiography to confirm repair, de-airing, weaning from bypass, chest closure, and transfer to the pediatric cardiac intensive care unit for postoperative monitoring and ventilatory support. Postoperative care includes hemodynamic monitoring, anticoagulation management if indicated by the device, pain control, infection surveillance, and scheduled follow-up echocardiography and cardiology visits.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No procedural modifier (default) | Use as the default when no other modifier applies for reporting the primary service |