CPT 33677 Ventricular Septal Defect Repair Reimbursement | OpenPayer

Summary & Overview

CPT 33677: Ventricular Septal Defect Closure with Pulmonary Artery Repair

CPT code 33677 is a cardiac surgical code for closure of multiple ventricular septal defects with sutures or patch grafts combined with removal of a pulmonary artery band and repair of the pulmonary artery defect. This procedure addresses hemodynamic instability caused by intracardiac shunts, reduces left-to-right shunting, and is central to definitive surgical management of certain congenital heart conditions. Nationally, the code matters because it captures complex inpatient cardiac surgical care with implications for surgical quality, resource use, and reimbursement across major payers. 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, expected site-of-service considerations, and an overview of common billing modifiers associated with the code. The publication summarizes benchmarks where available, highlights policy or coverage considerations affecting authorization and facility billing, and explains how 33677 fits within cardiac surgical service lines and inpatient coding workflows. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 33677ventricular septal defect repaircardiac surgerypulmonary artery repairinpatient surgerycongenital heart diseaseoperative codingsurgical billing

Billing Code Overview

CPT code 33677 describes a cardiac surgical procedure in which the provider closes multiple ventricular septal defects using sutures or patch grafts to prevent mixing of oxygenated and deoxygenated blood between the heart’s ventricles. The procedure includes removal of a previously placed pulmonary artery band and repair of the resulting pulmonary artery defect, with optional use of a gusset for reinforcement.

Service type: Surgical repair of congenital heart defects (open cardiac surgery)
Typical site of service: Inpatient hospital operating room (cardiac surgery suite), often performed as part of congenital or pediatric cardiac surgery care

Clinical & Coding Specifications

Clinical Context

A 6-month-old infant with a history of congenital heart disease presents for surgical repair of multiple ventricular septal defects (VSDs) and removal of a previously placed pulmonary artery (PA) band. The patient was initially palliated with PA banding in the neonatal period to limit pulmonary overcirculation. Preoperative assessment includes transthoracic echocardiography demonstrating multiple peri-membranous and muscular VSDs with significant left-to-right shunt, cardiology evaluation, and cardiopulmonary anesthesia planning. In the operating room under general endotracheal anesthesia, median sternotomy is performed, cardiopulmonary bypass instituted, and the surgeon closes several VSDs with direct sutures and patch grafts as needed to restore interventricular septal integrity and prevent mixing of oxygenated and deoxygenated blood. The surgeon removes the PA band and repairs the pulmonary artery defect, possibly placing a reinforcement gusset if required. Intraoperative transesophageal echocardiography confirms adequate repair and absence of residual significant shunt. Postoperative care includes pediatric cardiac intensive care unit monitoring, ventilatory and hemodynamic support, postoperative echocardiography, and staged removal of invasive lines as clinically appropriate.

Coding Specifications

Modifier	Description	When to Use
`00`	Default — no modifier	Use when no other modifier applies.

CPT 33690: Pulmonary Artery Banding to Restrict Pulmonary Blood Flow

CPT-33676-VENTRICULAR-SEPTAL-DEFECT-CLOSURE-WITH-PULMONARY-VALVOTOMY

CPT 33676: VSD Closure with Pulmonary Valvotomy or Infundibular Resection

CPT-33641-OPEN-ATRIAL-SEPTAL-DEFECT-PATCH-CLOSURE

CPT 33641: Open Atrial Septal Defect Patch Closure

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

CPT 33675: Closure of Multiple Ventricular Septal Defects

CPT-33660-CARDIAC-SEPTAL-AND-VALVE-REPAIR

CPT 33660: Cardiac Septal Closure with Valve Repair

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

CPT 33665: Atrioventricular Canal Defect Repair with Valve Reconstruction

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

CPT 33647: Atrial and Ventricular Septal Defect Repair

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

CPT 33645: Sinus Venosus Atrial Septal Defect Closure

CPT-33681-VENTRICULAR-SEPTAL-DEFECT-REPAIR-PATCH-OR-SUTURE

CPT 33681: Ventricular Septal Defect Repair With Patch or Sutures

CPT-33694-TETRALOGY-OF-FALLOT-REPAIR-VSD-PATCH-PULMONARY-ANNULUS-ENLARGEMENT

CPT 33694: Tetralogy of Fallot Repair with VSD Patch and Pulmonary Annulus Enlargement

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Taxonomy Code	Specialty	Notes
`207RG0300X`	Pediatric Cardiac Surgeon	Primary specialty performing pediatric VSD repairs and PA reconstruction.
`207RH0000X`	Thoracic/Cardiac Surgeon	Adult and complex congenital cardiac surgeons who perform intracardiac repairs.
`207T00000X`	Cardiothoracic Surgery	Broad taxonomy covering surgeons performing open-heart VSD closures.
`207LP2900X`	Pediatric Cardiovascular Surgeon	Provider focused on surgical management of congenital heart disease in children.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q21.0`	Ventricular septal defect	Primary congenital diagnosis indicating the need for surgical VSD closure.
`Q20.0`	Common truncus arteriosus	Associated congenital cardiac anomaly that may include VSDs requiring repair.
`Q21.3`	Tetralogy of Fallot	Commonly includes VSD requiring closure; may have prior PA shunt or banding.
`I34.0`	Nonrheumatic mitral (valve) insufficiency	May be present as concomitant pathology needing evaluation during intracardiac repair.
`P07.0`	Extremely low birth weight newborn (less than 1000 grams)	Relevant for coding neonatal modifiers and perioperative risk when applicable.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33405`	Valvuloplasty, mitral valve, with cardiopulmonary bypass; open	May be performed in the same operative setting if concurrent valve pathology is corrected during intracardiac repair.
`33426`	Replacement, aortic valve, with cardiopulmonary bypass	Performed when structural valve disease is identified and requires replacement during the same surgical admission.
`33533`	Coronary artery bypass, single arterial graft	Used in adults when coronary revascularization is required concurrently with cardiac repairs; rarely applicable in pediatric VSD repair but listed when multi-procedure adult repairs occur.
`93451`	Right and left heart catheterization including intraprocedural injection(s) for selective coronary angiography	Diagnostic catheterization may precede surgical repair in certain cases for hemodynamic assessment.
`93312`	Echocardiography, transesophageal, real-time with image documentation	Intraoperative transesophageal echocardiography is commonly used to assess VSD closure and valve function during the procedure.

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