Summary & Overview
CPT 33776: Mustard/Senning Atrial Baffle Repair with VSD Closure
CPT code 33776 identifies a complex congenital cardiac surgery — the Mustard or Senning type atrial baffle repair with closure of a ventricular septal defect performed on cardiopulmonary bypass. Nationally, this code represents high-acuity, resource-intensive inpatient cardiac procedures commonly performed at specialized centers. It is consequential for hospital surgical services, bundled payment considerations, and congenital cardiac program capacity planning.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and payment policies for this code typically reflect inpatient surgical benefit structures, case complexity, and facility-level considerations for cardiothoracic surgery.
Readers will find clinical context for the procedure, typical site-of-service expectations, and the types of insights commonly analyzed around this code, including utilization benchmarks, payer policy variations, and coding considerations relevant to cardiac surgical programs. Data not available in the input is noted where applicable, and the summary focuses on national-level implications rather than state-specific rules.
Billing Code Overview
CPT code 33776 describes a surgical repair of a congenital cardiac defect in which the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle, using a constructed baffle or tunnel (Mustard or Senning type procedure) with cardiopulmonary bypass and closure of a ventricular septal defect. This procedure reroutes deoxygenated and oxygenated blood by constructing an intra-atrial baffle from pericardium or atrial valve tissue.
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Service type: Major open cardiac surgery for congenital heart disease, specifically atrial-level baffle (Mustard/Senning) with ventricular septal defect closure.
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Typical site of service: Inpatient hospital operating room with cardiopulmonary bypass and postoperative inpatient care.
Clinical & Coding Specifications
Clinical Context
A pediatric or young adult patient with d-transposition of the great arteries (complete transposition) and an associated ventricular septal defect presents for surgical correction. The patient commonly has cyanosis, oxygen desaturation, and signs of congestive heart failure or failure to thrive in infancy, or progressive exercise intolerance if older. Preoperative evaluation includes echocardiography to confirm anatomy, cardiac catheterization if anatomy or pulmonary vascular resistance needs assessment, routine labs, and anesthesia and cardiothoracic surgery consultation. The operating room workflow includes median sternotomy, institution of cardiopulmonary bypass, construction of an intra-atrial baffle (Mustard or Senning type) to redirect systemic and pulmonary venous return, and closure of the ventricular septal defect when present. Postoperative care occurs in a pediatric or adult cardiothoracic intensive care unit with mechanical ventilation, vasoactive support as needed, rhythm monitoring for arrhythmias, and staged mobilization and discharge planning with cardiology follow-up and long-term surveillance for baffle obstruction, arrhythmia, and right ventricular function when applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Office or other outpatient visit for the evaluation and management | Use when the procedure is performed in an outpatient preoperative clinic visit setting for pre-op evaluation (rare for this inpatient procedure). |