Summary & Overview
CPT 33665: Atrioventricular Canal Defect Repair with Valve Reconstruction
CPT code 33665 identifies surgical repair of an atrioventricular (AV) canal defect, a congenital cardiac lesion requiring closure of septal defects and restoration of atrioventricular valve function. This code captures complex open-heart procedures that can include valve repair or valve replacement when structural damage is severe. Nationally, coding and reimbursement for congenital heart repairs like this matter because they involve high-resource inpatient care, specialized surgical teams, and potential long-term follow-up.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and billing-focused overview of the procedure and its typical site of service, plus guidance on what to expect in payer coverage patterns and documentation emphasis for complex congenital cardiac surgery. The publication highlights benchmarks related to service intensity and inpatient utilization, summarizes relevant policy considerations affecting authorization and coverage, and provides clinical context to support accurate claim submission for centers performing congenital cardiac surgery.
Data not available in the input for associated taxonomies, specific payer policy edits, and ICD-10 diagnoses. The content is intended as a national overview of the code's clinical meaning, service setting, and payer relevance.
Billing Code Overview
CPT code 33665 describes surgical repair of an atrioventricular (AV) canal defect by closing the septal defect and restoring valve competence. The procedure addresses abnormal mixing of blood between heart chambers and may include repair or, when necessary, replacement of the affected valve with a mechanical or tissue prosthesis based on defect severity.
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Service type: Cardiac congenital defect repair, open heart surgery
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Typical site of service: Inpatient hospital, operating room, cardiothoracic surgical service
Clinical & Coding Specifications
Clinical Context
A typical patient is an infant or young child diagnosed with a complete or partial atrioventricular septal defect (AV canal defect) presenting with signs of congestive heart failure, poor weight gain, recurrent pulmonary infections, or a heart murmur on exam. Preoperative evaluation includes transthoracic echocardiography confirming the anatomy of the common atrioventricular valve(s) and septal defects, chest radiography, electrocardiogram, and cardiology consultation. The patient is admitted to the pediatric cardiac surgery service, undergoes general endotracheal anesthesia, and has median sternotomy with cardiopulmonary bypass for intracardiac repair. The surgical procedure closes the atrial and/or ventricular septal defects and repairs or, if necessary, replaces the common AV valve to restore competent valve function and separate systemic and pulmonary circulations. Postoperative care occurs in the cardiac intensive care unit with hemodynamic monitoring, ventilatory support as needed, inotropic support, and serial echocardiography to assess repair integrity before transfer to the step-down unit and eventual discharge.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier or not otherwise specified | General: use when no specific modifier applies to the surgeon's claim |
11 |