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CPT 33684: Ventricular Septal Defect Repair with Outflow Tract Reconstruction

CPT code 33684 represents open surgical repair of a ventricular septal defect (VSD) with patch or sutures and simultaneous relief of ventricular outflow tract obstruction by incising pulmonary valve leaflets and removing obstructing tissue. This procedure is performed to stop mixing of oxygenated and deoxygenated blood and to restore unobstructed ventricular egress, making it a critical intervention in congenital and acquired cardiac disease. Nationally, accurate coding of complex cardiac surgical procedures affects quality measurement, hospital reimbursement, and benchmarking for specialized cardiovascular programs.

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, and which payer categories are relevant for coverage discussions. The publication also outlines typical modifiers used in billing when available and highlights what benchmarking and policy-related details are commonly sought for high-acuity cardiac surgical codes.

This summary prepares clinicians, coders, and policy analysts to understand the clinical intent of CPT code 33684, the settings where it is delivered, and the payer mix that matters for national reimbursement and quality tracking. Data not available in the input is noted where applicable in detailed sections.

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Billing Code Overview

CPT code 33684 describes a surgical procedure to close a ventricular septal defect by patch or sutures and to relieve obstruction of the ventricular outflow tract by incising pulmonary valve leaflets and removing obstructing tissue. The procedure addresses abnormal communication between the left and right ventricles and concurrent obstruction to blood flow from the ventricle to the pulmonary artery.

Service type: Open cardiac surgical repair of ventricular septal defect with ventricular outflow tract reconstruction
Typical site of service: Inpatient hospital operating room (cardiac surgery suite) or tertiary care cardiac center

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CPT 33684: Ventricular Septal Defect Repair with Outflow Tract Reconstruction

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Get alerted when payer policies referencing 33684 are released or updated.

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Billing Code Overview

Service type: Open cardiac surgical repair of ventricular septal defect with ventricular outflow tract reconstruction
Typical site of service: Inpatient hospital operating room (cardiac surgery suite) or tertiary care cardiac center

Clinical & Coding Specifications

Clinical Context

A pediatric or adult patient presents with symptoms of a hemodynamically significant ventricular septal defect (VSD) and associated right ventricular outflow tract (RVOT) obstruction due to hypertrophied muscle or obstructive tissue at the infundibulum or pulmonary valve. Typical clinical findings include heart murmur, exertional dyspnea, poor weight gain in infants, cyanosis in significant shunts, or progressive right ventricular pressure overload on echocardiography. Preoperative evaluation includes transthoracic or transesophageal echocardiography to delineate the VSD size and location and assess RVOT obstruction, cardiac catheterization when indicated for pressure gradients or coronary anatomy, baseline laboratory testing, and anesthesiology and cardiothoracic surgical assessment.

The operating surgeon performs surgical closure of the VSD with a patch or direct suture technique and concurrently relieves RVOT obstruction by incising pulmonary valve leaflets at their junction (valvotomy) and resecting obstructing subvalvular muscle or tissue. The procedure is typically performed in an operating room or cardiac surgery suite with cardiopulmonary bypass. Postoperative care includes intensive care unit monitoring, echocardiographic assessment of repair integrity and residual gradients, pain control, infection prophylaxis, and staged discharge planning with outpatient cardiology follow-up for anticoagulation or endocarditis prophylaxis guidance as indicated.

Coding Specifications

Modifier	Description	When to Use
`00`	Default or unspecified modifier (not a standard CMS modifier for billing)	Rarely used; use payer-specific guidance when required to indicate unmodified service.
`11`	Office or outpatient E/M (non-standard here)	Not typically appended to surgical CPT; included only if payer-specific policy requires.
`22`	Increased procedural services	Use when the work, time, and effort for the procedure substantially exceed the usual services for `33684`.
`23`	Unusual anesthesia	Use when general anesthesia is contraindicated and an unusual anesthesia circumstance is required.
`26`	Professional component	Use when reporting only the surgeon’s professional component separate from facility technical component, per payer policy.
`50`	Bilateral procedure	Use only if bilateral anatomic work applies (rare for this code); most often not applicable.
`51`	Multiple procedures	Use when `33684` is reported with other unrelated procedures during the same operative session to indicate multiple procedures performed.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as planned but still documented and medically necessary.
`53`	Discontinued procedure	Use when the procedure is started but halted in a way that meets payer criteria for `53` rather than a different modifier.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons throughout the case and documentation supports equal participation.
`63`	Procedure performed on infants less than 4 kg	Use when patient size-specific modifier is required by payer (neonatal cardiac surgery scenarios).
`78`	Unplanned return to the OR	Use when the patient returns to the operating room for a related procedure during the global period.
`80`	Assistant surgeon	Use when a surgical assistant (non-physician or physician assistant) provided assistance and payer accepts `80`.
`81`	Minimum assistant surgeon	Use when minimal assistance is provided and payer recognizes `81`.
`82`	Assistant surgeon (when a qualified resident is not available)	Use when an assistant surgeon is required and resident coverage is not available.

Taxonomy Code	Specialty	Notes
208100000X	Cardiothoracic Surgery	Primary specialty performing open VSD closure and RVOT procedures.
207RP1001X	Pediatric Cardiac Surgery	Subspecialty for infants and children with congenital VSD and RVOT obstruction.
207RG0200X	Thoracic Surgery	Surgeons with thoracic focus who may perform complex congenital repairs in some centers.
208000000X	Cardiac Surgery	General cardiac surgical taxonomy used in credentialing and billing contexts.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q21.0`	Ventricular septal defect	Primary indication for surgical closure when defect is hemodynamically significant or associated with RVOT obstruction.
`Q22.1`	Pulmonary valve stenosis	Common cause of RVOT obstruction that may be treated by incising pulmonary valve leaflets during the procedure.
`Q21.3`	Tetralogy of Fallot	Congenital condition combining VSD and RVOT obstruction; surgical repair often includes VSD closure and relief of RVOT obstruction.
`I35.0`	Nonrheumatic aortic (valve) stenosis	Less directly related but may coexist in adult patients with congenital defects; not a primary pediatric diagnosis for this procedure.
`I34.1`	Nonrheumatic mitral (valve) insufficiency	Included for completeness in adults with multiple valvular lesions; may affect perioperative assessment but is not a direct indication for `33684`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33405`	Repair of ventricular septal defect; in infants and children — open approach	Alternative or adjunct code used for VSD repairs in specific age groups or technique differences; may be reported when coding specifics differ from `33684`.
`33533`	Repair of tetralogy of Fallot; intracardiac repair including boot-shaped patch and relief of RVOT obstruction	Related congenital cardiac repair where VSD closure and RVOT relief are integral; used when part of a more extensive primary repair.
`33426`	Repair of congenital anomalies; transannular patch for RVOT reconstruction	May be performed when RVOT obstruction requires outflow tract reconstruction beyond simple valvotomy.
`93503`	Catheterization, cardiac, left heart, for congenital heart disease evaluation	Preoperative diagnostic cardiac catheterization often performed to assess pressures, gradients, and coronaries prior to surgical repair.
`93312`	Echocardiography, transesophageal, intraoperative or perioperative	Intraoperative or perioperative TEE commonly used to assess VSD closure completeness and residual RVOT obstruction immediately after repair.

CPT 33641: Open Atrial Septal Defect Patch Closure

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

CPT 33645: Sinus Venosus Atrial Septal Defect Closure

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

CPT 33647: Atrial and Ventricular Septal Defect Repair

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-33670-CARDIAC-SEPTA-AND-VALVE-REPAIR-REPLACEMENT

CPT 33670: Cardiac Septa and Valve Repair or Replacement

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

CPT 33675: Closure of Multiple Ventricular Septal Defects

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

CPT 33676: VSD Closure with Pulmonary Valvotomy or Infundibular Resection

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

CPT 33677: Ventricular Septal Defect Closure with Pulmonary Artery Repair

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

CPT 33681: Ventricular Septal Defect Repair With Patch or Sutures

Showing 1–10 of 15

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	Default or unspecified modifier (not a standard CMS modifier for billing)	Rarely used; use payer-specific guidance when required to indicate unmodified service.
`11`	Office or outpatient E/M (non-standard here)	Not typically appended to surgical CPT; included only if payer-specific policy requires.
`22`	Increased procedural services	Use when the work, time, and effort for the procedure substantially exceed the usual services for `33684`.
`23`	Unusual anesthesia	Use when general anesthesia is contraindicated and an unusual anesthesia circumstance is required.
`26`	Professional component	Use when reporting only the surgeon’s professional component separate from facility technical component, per payer policy.
`50`	Bilateral procedure	Use only if bilateral anatomic work applies (rare for this code); most often not applicable.
`51`	Multiple procedures	Use when `33684` is reported with other unrelated procedures during the same operative session to indicate multiple procedures performed.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as planned but still documented and medically necessary.
`53`	Discontinued procedure	Use when the procedure is started but halted in a way that meets payer criteria for `53` rather than a different modifier.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons throughout the case and documentation supports equal participation.
`63`	Procedure performed on infants less than 4 kg	Use when patient size-specific modifier is required by payer (neonatal cardiac surgery scenarios).
`78`	Unplanned return to the OR	Use when the patient returns to the operating room for a related procedure during the global period.
`80`	Assistant surgeon	Use when a surgical assistant (non-physician or physician assistant) provided assistance and payer accepts `80`.
`81`	Minimum assistant surgeon	Use when minimal assistance is provided and payer recognizes `81`.
`82`	Assistant surgeon (when a qualified resident is not available)	Use when an assistant surgeon is required and resident coverage is not available.

Taxonomy Code	Specialty	Notes
208100000X	Cardiothoracic Surgery	Primary specialty performing open VSD closure and RVOT procedures.
207RP1001X	Pediatric Cardiac Surgery	Subspecialty for infants and children with congenital VSD and RVOT obstruction.
207RG0200X	Thoracic Surgery	Surgeons with thoracic focus who may perform complex congenital repairs in some centers.
208000000X	Cardiac Surgery	General cardiac surgical taxonomy used in credentialing and billing contexts.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q21.0`	Ventricular septal defect	Primary indication for surgical closure when defect is hemodynamically significant or associated with RVOT obstruction.
`Q22.1`	Pulmonary valve stenosis	Common cause of RVOT obstruction that may be treated by incising pulmonary valve leaflets during the procedure.
`Q21.3`	Tetralogy of Fallot	Congenital condition combining VSD and RVOT obstruction; surgical repair often includes VSD closure and relief of RVOT obstruction.
`I35.0`	Nonrheumatic aortic (valve) stenosis	Less directly related but may coexist in adult patients with congenital defects; not a primary pediatric diagnosis for this procedure.
`I34.1`	Nonrheumatic mitral (valve) insufficiency	Included for completeness in adults with multiple valvular lesions; may affect perioperative assessment but is not a direct indication for `33684`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33405`	Repair of ventricular septal defect; in infants and children — open approach	Alternative or adjunct code used for VSD repairs in specific age groups or technique differences; may be reported when coding specifics differ from `33684`.
`33533`	Repair of tetralogy of Fallot; intracardiac repair including boot-shaped patch and relief of RVOT obstruction	Related congenital cardiac repair where VSD closure and RVOT relief are integral; used when part of a more extensive primary repair.
`33426`	Repair of congenital anomalies; transannular patch for RVOT reconstruction	May be performed when RVOT obstruction requires outflow tract reconstruction beyond simple valvotomy.
`93503`	Catheterization, cardiac, left heart, for congenital heart disease evaluation	Preoperative diagnostic cardiac catheterization often performed to assess pressures, gradients, and coronaries prior to surgical repair.
`93312`	Echocardiography, transesophageal, intraoperative or perioperative	Intraoperative or perioperative TEE commonly used to assess VSD closure completeness and residual RVOT obstruction immediately after repair.

CPT 33641: Open Atrial Septal Defect Patch Closure

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

CPT 33645: Sinus Venosus Atrial Septal Defect Closure

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

CPT 33647: Atrial and Ventricular Septal Defect Repair

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-33670-CARDIAC-SEPTA-AND-VALVE-REPAIR-REPLACEMENT

CPT 33670: Cardiac Septa and Valve Repair or Replacement

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

CPT 33675: Closure of Multiple Ventricular Septal Defects

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

CPT 33676: VSD Closure with Pulmonary Valvotomy or Infundibular Resection

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

CPT 33677: Ventricular Septal Defect Closure with Pulmonary Artery Repair

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

CPT 33681: Ventricular Septal Defect Repair With Patch or Sutures

Showing 1–10 of 15

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 33684: Ventricular Septal Defect Repair with Outflow Tract Reconstruction

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Billing Code Overview

OpenPayer

CPT 33684: Ventricular Septal Defect Repair with Outflow Tract Reconstruction

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References