Summary & Overview
CPT 33615: Atrial Septal Defect Patch and Pulmonary Artery Anastomosis
CPT code 33615 represents a complex congenital cardiac surgical repair that combines closure of an atrial septal defect with a patch and surgical anastomosis of the pulmonary artery to correct tricuspid atresia. This procedure is clinically significant because it addresses structural defects present at birth that obstruct normal right-heart inflow and pulmonary circulation; timely surgical correction can be essential for physiological stability and long-term outcomes. National stakeholders — including commercial payers and Medicare — cover and review billing and clinical documentation for such high-acuity inpatient procedures due to the resource intensity and specialty care required.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent of the code, expected site-of-service and service type, common billing modifiers associated with complex surgeries (listed separately), and the types of benchmarks and policy items typically relevant for high-complexity congenital cardiac surgery. The publication summarizes payer coverage patterns, typical documentation elements that support medical necessity, and considerations for claims processing and coding accuracy. It also highlights where national policy updates and payer guidelines commonly intersect with clinical practice for congenital cardiac procedures.
Billing Code Overview
CPT code 33615 describes a surgical procedure to repair congenital cardiac defects. The provider closes an atrial septal defect with a patch graft and then performs an anastomosis connecting the pulmonary artery to either the atria or the vena cava to correct tricuspid atresia (congenital absence of the opening between the right atrium and right ventricle).
Service Type: Open congenital cardiac surgical repair
Typical Site of Service: Inpatient hospital operating room / cardiovascular surgery suite
Clinical & Coding Specifications
Clinical Context
A pediatric or congenital cardiac surgery patient with tricuspid atresia and an associated atrial septal defect (ASD) presents for surgical correction. Typical presentation includes cyanosis, failure to thrive, hypoxemia, and evidence of right-sided flow obstruction on echocardiography. Preoperative workup includes transthoracic echocardiogram, cardiac catheterization when indicated to assess pulmonary vascular resistance and coronary anatomy, chest radiography, baseline labs, and crossmatch for blood products. An interdisciplinary team—pediatric cardiology, cardiothoracic surgery, pediatric anesthesia, perfusionists, and intensive care—coordinates care.
The operative workflow: median sternotomy, institution of cardiopulmonary bypass, exposure of the atrial septum, closure of the ASD with a patch graft to direct systemic venous return appropriately, and creation of a systemic-to-pulmonary connection by anastomosing the pulmonary artery to either the atrium or vena cava (Fontan-type or atriopulmonary connections tailored for tricuspid atresia). Intraoperative monitoring includes transesophageal echocardiography, arterial and central venous lines, and frequent blood gas analysis. Postoperative management occurs in a pediatric cardiac intensive care unit with ventilatory support, inotropic support as needed, fluid management, and staged anticoagulation. Typical site of service is an inpatient tertiary care hospital with a pediatric cardiac surgery program; service type is an open congenital cardiac surgical repair under cardiopulmonary bypass. Typical patient scenario: an infant or child with cyanosis and decreased oxygen saturation unresponsive to medical management undergoing definitive surgical correction of tricuspid atresia with ASD patch closure and pulmonary artery anastomosis.
Coding Specifications
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