Summary & Overview
CPT 33778: Arterial Switch (Jatene) Procedure
CPT code 33778 denotes the arterial switch (Jatene) procedure, a complex open-heart surgical repair for dextro-transposition of the great arteries in which the aorta and pulmonary artery are surgically transposed to their normal ventriculoarterial positions. This code captures a high-acuity congenital cardiac operation typically performed in specialized pediatric cardiac centers and carries significant implications for hospital resource use, perioperative care, and long-term follow-up.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and the payers commonly covering such inpatient congenital cardiac surgeries. The publication provides national-level benchmarks and coding guidance, highlights payer coverage patterns and authorization considerations where applicable, and summarizes policy and billing factors that affect reimbursement and documentation for high-risk pediatric cardiac surgery.
The content is aimed at clinicians, coding professionals, and health policy analysts seeking a clear, nationally focused reference on CPT code 33778, its clinical significance, and the payer landscape relevant to inpatient congenital cardiac surgical care.
Billing Code Overview
CPT code 33778 describes a surgical correction of a congenital cardiac malposition in which the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. This operation, commonly called an arterial switch or Jatene procedure, involves transecting and switching the transposed great arteries to restore normal ventriculoarterial connections.
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Service type: Open congenital cardiac surgery
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Typical site of service: Inpatient cardiac surgery performed in a hospital operating room with postoperative care in an intensive care unit or specialized pediatric cardiac unit.
Clinical & Coding Specifications
Clinical Context
A full-term neonate (age 1–28 days) presents with cyanosis, differential oxygen saturations, and a heart murmur on newborn exam. Echocardiography confirms dextro-transposition of the great arteries (d-TGA) with intact ventricular septum and no significant coronary anomalies. The cardiothoracic surgery team evaluates the infant, discusses timing of an arterial switch (Jatene) procedure, and schedules surgery within the first few weeks of life. Preoperative workflow includes: assessment by pediatric cardiology, diagnostic imaging (echocardiogram, chest x-ray), preoperative labs and blood type, coronary artery anatomy mapping via echocardiography or cardiac catheterization if needed, and anesthesia evaluation. Intraoperative management involves cardiopulmonary bypass, mobilization and transfer of the coronary arteries, transection and translocation of the aorta and pulmonary artery with reconstruction of the great vessel roots, and patching as required. Postoperative workflow includes ICU care with mechanical ventilation, inotropic support as needed, serial echocardiography to assess ventricular function and coronary perfusion, pain control, feeding advancement, and discharge planning with outpatient pediatric cardiology follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | Use when no modifier applies and the procedure is billed as usual |