Summary & Overview
CPT 33692: Tetralogy of Fallot Repair with VSD Patch and RVOT Resection
CPT code 33692 denotes surgical repair of tetralogy of Fallot through placement of a patch graft to close a ventricular septal defect and resection of infundibular muscle to relieve right ventricular outflow tract obstruction. This definitive congenital cardiac procedure is performed primarily in inpatient hospital settings and is central to pediatric and adult congenital heart programs. Nationally, accurate coding and classification of this procedure affect quality reporting, surgical registries, and payment pathways for complex congenital cardiac care.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for 33692, an outline of typical sites of service and service type, and guidance on which stakeholders commonly cover this service. The publication summarizes benchmarks and policy considerations relevant to high-acuity cardiac procedures and highlights areas where coding clarity supports appropriate claims processing and quality measurement. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 33692 describes surgical repair of tetralogy of Fallot by placement of a patch graft to close a ventricular septal defect and resection of obstructing muscle from the infundibulum to relieve right ventricular outflow tract obstruction. This procedure is a corrective congenital cardiac surgery that addresses both ventricular septal defect closure and right ventricular outflow tract reconstruction.
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Service type: Corrective congenital cardiac surgery involving ventricular septal defect repair and right ventricular outflow tract intervention
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Typical site of service: Inpatient hospital setting, commonly performed in a cardiothoracic operating room with postoperative care in a cardiac intensive care unit
Clinical & Coding Specifications
Clinical Context
A pediatric patient, typically an infant or young child diagnosed with tetralogy of Fallot, presents with cyanosis, failure to thrive, and episodes of hypoxic spells. Cardiology evaluation including echocardiography confirms a large ventricular septal defect (VSD), right ventricular outflow tract (RVOT) infundibular stenosis, overriding aorta, and right ventricular hypertrophy consistent with tetralogy of Fallot. The clinical workflow begins with preoperative cardiology and anesthesia assessments, cardiac catheterization or advanced imaging as needed for anatomical planning, and multidisciplinary surgical planning.
On the day of surgery the patient is taken to a cardiac operating room under general endotracheal anesthesia. A median sternotomy is performed, cardiopulmonary bypass initiated, and cardioplegic arrest achieved. The surgeon closes the VSD using a patch graft and performs resection of hypertrophied infundibular muscle (infundibulectomy) to relieve RVOT obstruction; additional procedures such as transannular patching may be performed if required. The patient is weaned from bypass, monitored in the pediatric cardiac intensive care unit postoperatively, and undergoes routine postoperative imaging and follow-up for residual shunt or RVOT gradients.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier appended | Used when no specific modifier is applicable to indicate unmodified service |