Summary & Overview
CPT 33694: Tetralogy of Fallot Repair with VSD Patch and Pulmonary Annulus Enlargement
CPT code 33694 denotes a comprehensive open surgical repair for tetralogy of Fallot, involving closure of a ventricular septal defect with a patch, resection of obstructive right ventricular muscle when necessary, and enlargement of the pulmonary annulus via patch graft. This code captures a complex congenital cardiac procedure that is central to pediatric and adult congenital cardiac programs and has implications for hospital resource use, surgical quality reporting, and payer coverage policies nationally. Key payers in the scope of this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise clinical description and coding context, typical settings of care, and the common modifier set associated with reporting. The publication outlines how CPT code 33694 maps to surgical service lines, expected inpatient utilization, and the clinical rationale for combining ventricular septal defect patch closure with pulmonary annulus enlargement. It also identifies where input data are available and where source elements are missing. The summary aids clinicians, coders, and policy analysts in understanding the clinical intent of the code, operational implications for hospitals, and the payer mix most commonly involved in coverage and authorization decisions. Data not available in the input are noted where relevant.
Billing Code Overview
CPT code 33694 describes a surgical repair of tetralogy of Fallot that closes a ventricular septal defect with a patch, removes obstructive muscle from the right ventricular outflow tract when needed, and enlarges the pulmonary annulus with a patch graft to correct pulmonary valve narrowing. This procedure is a corrective cardiac surgery addressing multiple anatomic defects characteristic of tetralogy of Fallot.
Service type: Open congenital cardiac surgery with ventricular septal defect closure and pulmonary annulus enlargement
Typical site of service: Inpatient hospital, operating room
Clinical & Coding Specifications
Clinical Context
A typical patient is a neonate, infant, child, or young adult diagnosed with tetralogy of Fallot (TOF) presenting with cyanosis, hypoxemic spells, exertional intolerance, or progressive right ventricular outflow tract obstruction. Preoperative evaluation includes echocardiography confirming a large perimembranous ventricular septal defect, right ventricular outflow tract (RVOT) obstruction, and pulmonary valve/annulus hypoplasia. Cardiac catheterization and cross-sectional imaging may be used for surgical planning when anatomy or pulmonary arteries require delineation.
In the operating room under general anesthesia and cardiopulmonary bypass, the surgeon closes the ventricular septal defect with a prosthetic patch, performs infundibular muscle resection as needed to relieve RVOT obstruction, and enlarges the pulmonary annulus with a transannular patch graft or valve-sparing patch depending on valve morphology. Intraoperative transesophageal echocardiography confirms repair adequacy and residual gradients. Postoperative care occurs in a pediatric or adult cardiac intensive care unit with hemodynamic monitoring, ventilatory support as needed, and serial imaging and ECG to assess for residual defects, arrhythmia, or right ventricular dysfunction. Typical sites of service are the operating room in an inpatient hospital setting and the cardiac intensive care unit for immediate postoperative care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |