Clinical Context
A typical patient is a pediatric or young adult with dextro-transposition of the great arteries (d-TGA) who previously underwent pulmonary artery banding or other staged palliation and now requires definitive intra-atrial baffle repair (Mustard or Senning-type) with removal of a prior pulmonary artery band. The patient is brought to the operating room after preoperative evaluation in cardiology and cardiac surgery clinics, with imaging (echocardiography, cardiac MRI or CT) confirming anatomy and function. Preoperative steps include anesthesia evaluation, informed consent, cross-matching blood, and placement of invasive monitoring. The cardiac surgeon performs a median sternotomy, places the patient on cardiopulmonary bypass, constructs an intra-atrial baffle or tunnel using autologous pericardium or atrial tissue to redirect systemic and pulmonary venous return, and removes the prior pulmonary artery band. The procedure may require concurrent arrhythmia assessment and repair of associated defects. Postoperative care occurs in a pediatric or cardiothoracic intensive care unit with hemodynamic monitoring, ventilatory support as needed, inotropic support, and early echocardiographic assessment to confirm baffle integrity and flow. Typical payors for authorization and claims include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|
00 | Service not specified | Data not available in the input. |
11 | Service was performed as planned (no complications) | Use when the operation proceeded as scheduled without unplanned return to the operating room.
22 | Unusual procedural services | Use when substantially greater work or resources are required (extensive adhesiolysis, complex reconstruction beyond typical baffle construction).
23 | Unusual anesthesia — medically necessary, patient not able to tolerate standard anesthesia | Use when severe comorbidity necessitates unusual anesthetic management.
52 | Reduced services | Use when the procedure is intentionally partially reduced or aborted and documentation supports reduced work.
53 | Discontinued procedure | Use when the procedure is started but stopped due to extenuating circumstances prior to completion.
62 | Two surgeons | Use when a second surgeon of the same specialty performs distinct operative work concurrently (complex congenital repair requiring co-surgeons).
63 | Procedure performed on infants less than 4 kg | Use when applicable for weight-based modifier reporting in certain payor scenarios.
66 | Surgical team | Use when surgical team reporting is appropriate for complex congenital cardiac procedures.
78 | Unplanned return to the operating room following initial procedure for a related procedure during the postoperative period | Use when a return to OR is required for revision of the baffle or bleeding control.
80 | Assistant surgeon present | Use when an assistant surgeon is documented and assists in the procedure.
81 | Minimum assistant surgeon | Use when a minimal assistant surgeon role is documented.
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Use when an APP serves as an assistant and payor accepts AS.
QX | CRNA service with non‑physician anesthesiologist direction | Use when a CRNA provides anesthesia with appropriate supervision and the payor requires QX.
| Taxonomy Code | Specialty | Notes |
|---|
207RP0000X | Cardiothoracic Surgery | Surgeons who perform congenital and adult cardiac repairs. |
207RT0003X | Pediatric Cardiac Surgery | Surgeons specializing in neonatal and pediatric congenital heart surgery.
207L00000X | Cardiology | Pediatric or adult congenital cardiologists involved in diagnosis and longitudinal management.
207K00000X | Critical Care Medicine | Pediatric or cardiac intensivists who manage postoperative ICU care.
207M00000X | Anesthesiology | Cardiac anesthesiologists who provide intraoperative anesthesia and cardiopulmonary bypass management.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
Q20.3 | Transposition of great vessels | Primary congenital anomaly indicating d-TGA for which intra-atrial baffle (Mustard/Senning) is performed. |
I42.8 | Other cardiomyopathies | May be present as secondary ventricular dysfunction requiring surgical planning and perioperative support.
Q25.1 | Pulmonary artery stenosis | Prior pulmonary artery banding or residual stenosis may be present and addressed during surgery.
I49.9 | Cardiac arrhythmia, unspecified | Arrhythmias are common in patients with intra-atrial baffles and may necessitate intraoperative or postoperative management.
Z95.2 | Presence of prosthetic heart valve | Relevant if prior surgeries included valve interventions affecting surgical approach.
Z98.890 | Other specified postprocedural states | Indicates prior cardiac surgical interventions such as pulmonary artery band placement that are removed during this procedure.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
00561 | Anesthesia for procedures on heart and pericardial cavity; age 1-5 years | Anesthesia code commonly reported for pediatric cardiac surgery including intra-atrial baffle repair. |
33210 | Insertion of temporary transvenous pacing electrode; for cardiac surgery perioperative pacing support | Reported if temporary pacing leads are placed intraoperatively for postoperative rhythm management.
33335 | Repair of congenital cardiac anomaly, other than septal defect, partial or total anomalous pulmonary venous return; open procedure | May be used for associated or additional congenital intracardiac repairs performed at the same operation.
33946 | Repair of total anomalous pulmonary venous connection, open; with cardiopulmonary bypass | Related complex congenital cardiac repair code that may be performed in similar operative settings (illustrative of concurrent complex repairs).
99024 | Postoperative follow-up visit, normally included in global period (hospital) | Used for postoperative hospital follow-up visits during the global period when billed separately by some facilities.