Summary & Overview
CPT 33619: Norwood Procedure for HLHS and Aortic Arch Reconstruction
CPT code 33619 codes the Norwood procedure, the first-stage open surgical reconstruction used to treat hypoplastic left heart syndrome (HLHS) and severe aortic arch hypoplasia in neonates and infants. This high-complexity congenital cardiac surgery is performed in specialized pediatric cardiac centers and is clinically critical because it establishes systemic circulation in patients with underdeveloped left-sided heart structures. Nationally, the procedure represents a concentrated resource use event with implications for surgical capacity, pediatric ICU resources, and post-operative longitudinal care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and billing-focused overview of the procedure, typical sites of service, common billing modifiers, and relevant coding context. The publication summarizes benchmarks and utilization patterns where available, highlights policy or reimbursement considerations affecting access to specialized pediatric cardiac surgery, and provides clinical context on why the Norwood stage is essential in multi-stage palliation for HLHS. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 33619 describes the Norwood procedure performed as the first stage of multi-stage surgical repair for aortic arch hypoplasia or hypoplastic left heart syndrome (HLHS). The operation reconstructs the aortic arch and establishes systemic blood flow in patients whose left ventricle, aorta, and mitral valve are underdeveloped.
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Service type: Complex neonatal or infant open congenital cardiac surgery
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Typical site of service: Inpatient, specialized pediatric cardiac surgical center
Clinical & Coding Specifications
Clinical Context
A full-term neonate diagnosed prenatally with hypoplastic left heart syndrome (HLHS) is delivered at a tertiary pediatric cardiac center. Within the first week of life, the infant develops signs of systemic hypoperfusion, hypoxemia, and a restrictive atrial septum on echocardiography. The multidisciplinary team — including a pediatric cardiac surgeon, pediatric cardiologist, neonatologist, perfusionist, and pediatric anesthesiologist — convenes to perform stage I palliation. The surgeon performs a Norwood procedure (33619) in the operating room under cardiopulmonary bypass to reconstruct the hypoplastic aortic arch, create a neoaorta from the hypoplastic native aorta and pulmonary root, and establish systemic blood flow with a source of pulmonary blood flow (e.g., modified Blalock–Taussig shunt or right ventricle-to-pulmonary artery conduit in a separate coded step). Postoperative care includes extended neonatal intensive care monitoring, ventilatory support, inotropic therapy, hemodynamic monitoring, and staged planning for the Glenn and Fontan procedures. Typical documentation includes preoperative imaging and catheterization reports, operative note specifying components of the Norwood reconstruction, bypass times, intraoperative complications, and postoperative course for accurate coding and billing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the Norwood procedure requires substantially greater work than typical due to complexity or complications, with supporting documentation. |