Summary & Overview
CPT 33920: Repair of Pulmonary Atresia with Ventricular Septal Defect
Headline: CPT code 33920: Surgical repair of pulmonary atresia with ventricular septal defect — major congenital cardiac reconstruction
Lead: CPT code 33920 identifies a complex congenital cardiac surgery in which a surgeon repairs pulmonary atresia and a ventricular septal defect by creating a conduit from a ventricle to the pulmonary artery. This one-time, high-acuity operative code represents a critical intervention for neonates and infants with life-threatening structural heart disease.
Why it matters: Nationally, procedures represented by CPT code 33920 are high-cost, high-resource inpatient services that concentrate specialized surgical, anesthetic and intensive care resources. Payer coverage, prior authorization practices, and facility designation affect access to timely repair and perioperative management for affected infants.
Payers covered: Analysis includes major national payers — Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication explains the clinical scope of CPT code 33920, expected site-of-service and care setting, and the role of this procedure within congenital cardiac care pathways. It summarizes common billing considerations and payer engagement topics. Where available, readers will find benchmarking context, typical authorization and inpatient care patterns, and policy updates relevant to congenital cardiac surgical services.
Data note: Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific coverage policy language.
Billing Code Overview
CPT code 33920 describes a surgical procedure to repair pulmonary atresia and concurrently close or repair a ventricular septal defect (VSD). The surgeon constructs a conduit or channel from the right or left ventricle to the pulmonary artery to establish blood flow to the lungs in an infant born with these congenital cardiac anomalies.
Service type: Cardiac congenital heart surgery; intracardiac repair with ventriculo-pulmonary conduit construction
Typical site of service: Inpatient hospital, operating room (cardiothoracic surgery)
Clinical & Coding Specifications
Clinical Context
A full-term neonate is diagnosed prenatally with complex congenital heart disease including pulmonary atresia with a ventricular septal defect confirmed by fetal echocardiography and postnatal transthoracic echocardiogram. After birth the infant demonstrates cyanosis and hypoxemia refractory to medical management. A multidisciplinary congenital cardiac team (pediatric cardiology, pediatric cardiothoracic surgery, neonatology, cardiac anesthesia, and perfusion) coordinates urgent surgical repair in a tertiary pediatric cardiac surgery center.
Preoperative workflow includes repeat echocardiography, cardiac catheterization if needed to delineate pulmonary artery anatomy, cross‑match and blood product preparation, and informed consent from guardians. The operative procedure involves median sternotomy, cardiopulmonary bypass, construction of a right-ventricle-to-pulmonary-artery (RV-PA) conduit or transannular patch to establish pulmonary blood flow, and closure of the ventricular septal defect. Intraoperative transesophageal echocardiography assesses repair adequacy. Postoperative care occurs in a pediatric cardiac intensive care unit with ventilatory support, inotropic support, monitoring for arrhythmia, residual shunt, conduit obstruction, and wound complications. Typical length of stay varies with complexity and comorbidities; staged reinterventions or catheter-based procedures may follow during infancy or childhood.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Procedure performed in an outpatient setting (placeholder standard) |