Summary & Overview
CPT 33697: VSD Patch Closure with RV‑to‑PA Conduit
CPT code 33697 denotes a complex cardiac surgical procedure that closes a ventricular septal defect (VSD) with a patch graft and establishes a conduit from the right ventricle to the pulmonary artery to bypass obstruction caused by an underdeveloped or absent pulmonary valve. This repair is clinically significant for congenital and structural heart disease management and carries implications for surgical resource use, postoperative intensive care, and long-term follow-up.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, expected service setting, and the primary considerations that influence coding and reimbursement for this high-acuity operative intervention. The publication outlines common billing considerations, typical sites of service, and clinical rationale for the combined VSD patch and right ventricle–to–pulmonary artery conduit approach.
The report addresses national-level benchmarks and policy-relevant updates where available, explains how the procedure is represented in claims, and summarizes the operational implications for hospitals and surgical teams. Data not available in the input is noted where applicable. The content is intended to inform coding managers, hospital billing teams, and policy analysts about the clinical nature and billing context of CPT code 33697.
Billing Code Overview
CPT code 33697 describes a surgical repair in which the provider closes a ventricular septal defect with a patch graft and places a tube graft between the right ventricle and the pulmonary artery. This procedure bypasses obstruction of blood flow caused by underdevelopment or absence of the pulmonary valve.
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Service type: Cardiac surgical repair involving intracardiac patch closure and right ventricle-to-pulmonary artery conduit placement
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Typical site of service: Hospital operating room, typically performed by cardiac/thoracic surgical teams with postoperative care in a cardiac intensive care unit or pediatric cardiac unit
Clinical & Coding Specifications
Clinical Context
A typical patient is an infant or young child with Tetralogy of Fallot with pulmonary atresia or severe pulmonary valve underdevelopment leading to right ventricular outflow tract obstruction and a large ventricular septal defect (VSD). The child presents with cyanosis, failure to thrive, tachypnea, or hypoxemic spells and undergoes diagnostic evaluation including echocardiography and cardiac catheterization confirming a VSD with pulmonary valve deficiency and inadequate pulmonary blood flow. The surgical team — pediatric cardiothoracic surgeon, pediatric cardiologist, anesthesiology, and perfusion staff — perform a corrective open-heart procedure under cardiopulmonary bypass.
Intraoperative workflow: median sternotomy, initiation of cardiopulmonary bypass, closure of the VSD with a patch graft, and placement of a right ventricle–to–pulmonary artery (RV-PA) conduit (tube graft) to bypass the obstructed native outflow tract. Hemostasis and conduit function are assessed, chest is closed with drains, and the patient is transferred to the pediatric cardiac intensive care unit for postoperative monitoring, ventilatory support, inotropic management, and staged follow-up including echo surveillance and potential future conduit revisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for 33697 and adequately documented. |