CPT 33676 VSD Closure Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 33676: VSD Closure with Pulmonary Valvotomy or Infundibular Resection

CPT code 33676 identifies an open cardiac surgical procedure that closes multiple ventricular septal defects and relieves right ventricular outflow tract obstruction through pulmonary valvotomy or infundibular resection. This procedure addresses both septal defects that permit mixing of oxygenated and deoxygenated blood and obstructive lesions that impede ventricular outflow, making it a critical intervention in congenital and structural cardiac cases. Nationally, the code matters because it captures complex combined cardiac repairs that impact inpatient surgical utilization, resource intensity, and inpatient payment frameworks.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, common modifiers listed in the input, and which payers are considered. The publication provides benchmarks and policy-relevant information where available and highlights areas with Data not available in the input when specific details (such as associated taxonomies, ICD-10 diagnoses, or related codes) are not provided. The content is intended for clinicians, coding professionals, and policy analysts seeking a clear summary of CPT code 33676 and its implications for billing and inpatient surgical reporting.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare33676CPTcardiac surgeryventricular septal defectpulmonary valvotomyinfundibular resectioninpatient surgery

Billing Code Overview

CPT code 33676 describes surgical repair of multiple ventricular septal defects (VSDs) using sutures or patch grafts to prevent mixing of oxygenated and deoxygenated blood between the ventricles. The procedure also includes a pulmonary valvotomy, in which the provider incises or resects pulmonary valve leaflets, or an infundibular resection, where obstructing muscle is removed from the right ventricular outflow tract to relieve obstruction.

Service type: Open cardiac surgical repair combining VSD closure and pulmonary outflow tract intervention
Typical site of service: Inpatient operating room or cardiac surgery suite within an acute hospital setting

Clinical & Coding Specifications

Clinical Context

A 6-year-old child with congenital tetralogy of Fallot presents with progressive cyanosis, exertional dyspnea, and a harsh systolic murmur. Preoperative evaluation includes echocardiography demonstrating right ventricular outflow tract (RVOT) obstruction from infundibular muscle hypertrophy and one or more perimembranous ventricular septal defects (VSDs), with associated pulmonary valve stenosis. The surgical plan is open repair: closure of the VSD(s) with sutures or patch grafts and relief of RVOT obstruction by pulmonary valvotomy or infundibular (ventricular outflow tract) muscle resection, as described in 33676.

Perioperative workflow: the patient undergoes general endotracheal anesthesia, median sternotomy, cardiopulmonary bypass, and cardioplegic arrest. The cardiac surgeon inspects and closes the VSD(s), then incises or resects pulmonary valve leaflets or removes obstructing muscle in the RVOT to relieve outflow tract obstruction. Hemostasis, weaning from bypass, and closure follow. Typical postoperative care includes intensive care unit monitoring, inotropic support as needed, chest tube management, and echocardiographic assessment of repair.

Typical site of service: inpatient hospital operating room with cardiothoracic surgery and postoperative care in a pediatric or adult cardiac intensive care unit depending on patient age and comorbidities.

Service type: open cardiac surgical repair combining intracardiac defect closure and RVOT/pulmonary valvular intervention.

Coding Specifications

Modifier	Description	When to Use

CPT 33641: Open Atrial Septal Defect Patch Closure

CPT-33677-VENTRICULAR-SEPTAL-DEFECT-CLOSURE-PULMONARY-ARTERY-REPAIR

CPT 33677: Ventricular Septal Defect Closure with Pulmonary Artery Repair

CPT-33665-AV-CANAL-DEFECT-REPAIR-CARDIAC-SEPTAL-AND-VALVE-RECONSTRUCTION

CPT 33665: Atrioventricular Canal Defect Repair with Valve Reconstruction

CPT-33688-VENTRICULAR-SEPTAL-DEFECT-REPAIR-WITH-PULMONARY-ARTERY-BAND-REMOVAL

CPT 33688: Ventricular Septal Defect Repair with Pulmonary Artery Band Removal

CPT-33647-ATRIAL-VENTRICULAR-SEPTAL-DEFECT-REPAIR

CPT 33647: Atrial and Ventricular Septal Defect Repair

CPT-33692-TETRALOGY-OF-FALLOT-REPAIR-VSD-PATCH-AND-RVOT-RESECTION

CPT 33692: Tetralogy of Fallot Repair with VSD Patch and RVOT Resection

CPT-33645-SINUS-VENOSUS-ATRIAL-SEPTAL-DEFECT-CLOSURE

CPT 33645: Sinus Venosus Atrial Septal Defect Closure

CPT-33675-VENTRICULAR-SEPTAL-DEFECT-CLOSURE-MULTIPLE-DEFECTS

CPT 33675: Closure of Multiple Ventricular Septal Defects

CPT-33684-VENTRICULAR-SEPTAL-DEFECT-REPAIR-WITH-OUTFLOW-TRACT-RECONSTRUCTION

CPT 33684: Ventricular Septal Defect Repair with Outflow Tract Reconstruction

CPT-33690-PULMONARY-ARTERY-BANDING-RESTRICT-PULMONARY-BLOOD-FLOW

CPT 33690: Pulmonary Artery Banding to Restrict Pulmonary Blood Flow

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Taxonomy Code	Specialty	Notes
207K00000X	Cardiovascular Thoracic Surgery	Primary specialty performing open VSD closure and RVOT procedures.
207L00000X	Cardiovascular Surgery	Surgeons focused on cardiac operative procedures that may perform this repair.
2080P0002X	Pediatric Cardiac Surgery	Pediatric specialists performing congenital heart repairs in infants and children.
207R00000X	Thoracic Surgery	Thoracic surgeons who may be involved in complex cardiac/thoracic operations.
207RA0001X	Cardiac Surgery (Adult)	Adult cardiac surgeons performing similar intracardiac repairs in adults with congenital disease.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q21.3`	Tetralogy of Fallot	Classic indication for combined VSD closure and relief of RVOT obstruction via pulmonary valvotomy or infundibular resection.
`Q21.0`	Ventricular septal defect	Direct indication for surgical closure of one or more VSDs as described in `33676`.
`I27.0`	Primary pulmonary hypertension	May coexist with RVOT/pulmonary valve pathology requiring surgical assessment; less common primary indication.
`Q22.1`	Pulmonary valve stenosis	Indication for pulmonary valvotomy or valve leaflet resection as part of the described procedure.
`Q21.8`	Other congenital malformations of cardiac septa	Includes complex septal defects that may require surgical closure and RVOT interventions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33510`	Repair of ventricular septal defect with cardiopulmonary bypass, simple	Alternative or adjunct code for isolated VSD repair; `33676` combines VSD closure with RVOT/pulmonary valvotomy procedures.
`33405`	Pulmonary valvotomy (open)	Procedure focusing on pulmonary valve leaflet incision; similar to the valvotomy component described within `33676`.
`33430`	Right ventricular outflow tract reconstruction (infundibular resection/grafting)	Codes for RVOT reconstruction that may be performed when more extensive repair than simple resection is required; may be billed in conjunction with VSD closure depending on intraoperative findings.
`93503`	Diagnostic cardiac catheterization for congenital heart disease	Preoperative diagnostic catheterization often performed to delineate anatomy prior to surgical repair.
`93620`	Intracardiac repair procedures; congenital heart disease (complex)	May describe more extensive congenital intracardiac repairs; used when multiple complex repairs beyond `33676` are performed.

`00`	No specific modifier — default	Use when no additional modifier applies.
`11`	Professional component	Use when reporting the surgeon's professional service distinct from facility billing (rare for operative CPT reporting).
`22`	Increased procedural services	Use when work required is substantially greater than typical for `33676` (document justification).
`23`	Unusual anesthesia — patient condition	Use when general anesthesia is contraindicated and additional risk due to patient condition increases anesthesia complexity.
`26`	Professional component	Use if reporting only the physician professional component separated from technical/facility charges.
`62`	Two surgeons	Use when two surgeons of different specialties or same specialty perform distinct portions of the procedure and both are reporting services.
`63`	Procedure performed on infants less than 4 kg	Use when the procedure is performed on an infant under 4 kg (pediatric modifier).
`78`	Return to operating room for related procedure during postoperative period	Use when patient returns to OR for a related complication or procedure during global period.
`79`	Unrelated procedure or service during postoperative period	Use when an unrelated procedure is performed during the global period (note: `79` is not in raw list; do not use).
`80`	Assistant surgeon	Use when an assistant surgeon performs assistance during `33676` and separately bills.
`81`	Minimum assistant surgeon	Use when a minimal assistant surgeon participates.
`82`	Assistant surgeon when qualified resident not available	Use when an assistant surgeon is required because no qualified resident is available.
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to extenuating circumstances.
`76`	Repeat procedure by same physician	Use when the same physician repeats the exact procedure later the same day (note: `76` is not in raw list; do not use).

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