Summary & Overview
CPT 33767: Bidirectional Glenn Superior Vena Cava to Right Pulmonary Artery Shunt
CPT code 33767 captures the bidirectional Glenn procedure: a pediatric or congenital cardiac surgery that connects the superior vena cava to the right pulmonary artery to divert systemic venous blood directly to the lungs. This staged palliative operation is a key component of single-ventricle management and matters nationally because it influences surgical volumes, inpatient cardiac surgical resource use, and congenital heart program benchmarking across payers.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context on the procedure and its typical inpatient surgical setting, payer coverage considerations, and what to expect in terms of service classification. The publication outlines common billing and coding considerations for hospital-based cardiac surgery lines and highlights areas where institutional policy or payer-specific prior authorization and coverage rules often apply.
The article also provides operational benchmarks and policy-focused insights relevant to hospital administrators, coding professionals, and cardiovascular program leaders. Where specific payer or claim-level data are not provided in the input, the text notes that such data are unavailable and focuses on the clinical and coding implications that are broadly applicable at the national level.
Billing Code Overview
CPT code 33767 describes a surgical bidirectional Glenn procedure in which a shunt is created between the superior vena cava and the right pulmonary artery to divert deoxygenated blood directly to the lungs. The operation forms a bypass channel that routes venous return around a defective right heart chamber so blood reaches the pulmonary artery for oxygenation.
Service Type: Cardiac surgical procedure, palliative/congenital heart surgery
Typical Site of Service: Inpatient hospital – operating room / cardiac surgery suite
Clinical & Coding Specifications
Clinical Context
A typical patient is an infant or young child with congenital single-ventricle physiology (for example, hypoplastic left heart syndrome after initial palliation, tricuspid atresia, or complex congenital heart disease) who requires staged surgical palliation to direct systemic venous blood to the pulmonary arteries. The child presents with cyanosis, hypoxemia, and reduced activity; preoperative evaluation includes echocardiography, cardiology consultation, cardiac catheterization to assess pulmonary artery anatomy and pressures, and routine preoperative labs. The procedure, a bidirectional Glenn (superior cavopulmonary anastomosis), is performed in the operating room under general anesthesia by a pediatric cardiothoracic surgical team. Intraoperative monitoring includes arterial line, central venous access, transesophageal echocardiography as indicated, and cardiopulmonary bypass if required. Postoperative care occurs in a pediatric cardiac intensive care unit with ventilatory support as needed, inotropic management, chest tube monitoring, and follow-up echocardiography to confirm shunt patency and pulmonary blood flow prior to stepwise staged repair (e.g., eventual Fontan completion). Documentation elements include indication, surgical approach, conduit/anastomosis details, cardiopulmonary bypass use and times, intraoperative complications, and postoperative condition and disposition.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — use as submitted | Use when no special circumstance modifier applies and only the primary procedure is reported |