Summary & Overview
CPT 33690: Pulmonary Artery Banding to Restrict Pulmonary Blood Flow
CPT code 33690 represents placement of a pulmonary artery band to restrict pulmonary blood flow and protect pulmonary vasculature in patients with congenital or structural cardiac conditions. This operative intervention is an important temporizing measure that can prevent ventricular dilation and elevated pulmonary artery pressures while clinicians plan more definitive repair. Nationally, the code is relevant to pediatric and congenital cardiac surgery programs and to payers that cover complex inpatient cardiac procedures.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent of the procedure, typical sites of service, and common billing considerations for inpatient cardiac surgery. The publication outlines benchmarking elements such as utilization patterns and reimbursement context where available, highlights recent policy or coding guidance affecting inpatient procedural billing, and summarizes clinical circumstances that commonly prompt use of the procedure. The goal is to provide a clear reference for clinicians, coding professionals, and policy analysts regarding the use and billing of CPT code 33690 across major national payers.
Billing Code Overview
CPT code 33690 describes a surgical procedure in which the provider places a pulmonary artery band around the aortopulmonary trunk, aorta, and pulmonary artery to restrict pulmonary blood flow. The band, often made of material such as umbilical tape, is used to protect pulmonary vessels, limit ventricular enlargement, and reduce pulmonary artery pressures while preparing the patient for more definitive cardiac procedures in the future.
-
Service type: Palliative cardiac surgical procedure to reduce pulmonary blood flow
-
Typical site of service: Inpatient operating room or cardiac surgery suite in a hospital setting
Clinical & Coding Specifications
Clinical Context
A full-term infant with a large, unrestricted ventricular septal defect (VSD) presents with signs of congestive heart failure and excessive pulmonary overcirculation despite medical management. The neonate has tachypnea, poor weight gain, hepatomegaly, and recurrent respiratory infections. Echocardiography demonstrates significant left-to-right shunt with elevated pulmonary artery pressures and risk for pulmonary vascular disease. The pediatric cardiothoracic surgery team schedules a palliative pulmonary artery banding procedure to reduce pulmonary blood flow and protect the pulmonary vasculature while awaiting definitive intracardiac repair.
Preoperative workflow includes cardiology evaluation, transthoracic echocardiogram, chest radiograph, basic labs, and anesthesia assessment. In the operating room under general anesthesia, median sternotomy or thoracotomy exposure is performed, and a band (eg, umbilical tape or surgical banding material) is placed around the main pulmonary artery/aortopulmonary trunk to achieve the targeted gradient and pulmonary blood flow reduction. Intraoperative monitoring includes arterial line, central venous access as indicated, transesophageal or epicardial echocardiography, and continuous hemodynamic assessment. Postoperative care occurs in a pediatric cardiac intensive care unit with ventilatory support, inotropic management as needed, and serial imaging to guide timing of definitive repair.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |