Summary & Overview
CPT 33735: Atrial Septum Removal or Creation
CPT code 33735 covers surgical removal or intentional creation of an opening in the atrial septum, a procedure affecting the wall between the heart’s right and left atria. This code captures a specialized cardiac surgery used in select clinical scenarios such as congenital defects, interventional facilitation, or hemodynamic management. Nationally, use of this code reflects access to advanced cardiac surgical services and impacts hospital surgical case mix and resource planning.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, national payer coverage considerations, and the types of benchmarks typically reviewed for high-acuity cardiac surgical codes. The publication presents information on expected sites of service, common billing modifiers associated with the code (listed separately), and where to look for coding guidance.
This summary is intended for hospital administrators, revenue cycle professionals, and clinical coding staff seeking a concise reference to the clinical meaning, payer landscape, and analytical focus areas tied to CPT code 33735. Data not available in the input where applicable.
Billing Code Overview
CPT code 33735 describes a surgical procedure in which the provider removes the atrial septum or intentionally creates an opening in the atrial septum, the wall of tissue separating the right and left atrium of the heart. This procedure can be performed to address congenital heart defects, facilitate cardiac hemodynamics, or enable other interventional strategies when clinically indicated.
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Service type: Surgical procedure on the heart involving alteration or removal of atrial septal tissue
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Typical site of service: Hospital operating room or cardiac surgical suite
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with symptomatic or hemodynamically significant interatrial communication or a clinical indication for creating or enlarging an atrial septal opening. A common scenario is a patient with refractory hypoxemia due to right-to-left shunting, elevated left atrial pressure requiring atrial decompression, or planned transseptal access during structural heart procedures where intentional atrial septostomy is performed. The clinical workflow begins with preoperative evaluation including transthoracic and transesophageal echocardiography to define septal anatomy, right and left atrial pressures, and shunt direction. The patient is brought to a cardiac catheterization lab or hybrid operating room. Under general anesthesia or monitored anesthesia care, vascular access (typically femoral venous) is obtained, and intracardiac imaging or transesophageal echocardiography guides septal puncture. The operator performs balloon atrial septostomy or creates/removes tissue in the atrial septum using cutting devices, blades, or transcatheter septostomy tools as indicated. Hemodynamic monitoring is used to confirm pressure changes and shunt flow. Postprocedural care includes recovery in a monitored setting with serial exams, echocardiography to document defect size and flow, anticoagulation management as indicated, and discharge planning with follow-up cardiology appointments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or complexity substantially exceeds typical for the procedure (document justification). |