Summary & Overview
CPT 33924: Systemic-to-Pulmonary Artery Shunt Revision with Congenital Repair
CPT code 33924 covers surgical ligation and reestablishment of a connection between the systemic artery and the pulmonary artery performed after a prior systemic–pulmonary shunt, combined with repair of a congenital heart anomaly. This procedure is clinically significant because it addresses complications or planned revisions after prior shunt procedures and simultaneously corrects structural heart defects present from birth, often requiring specialized cardiothoracic surgical teams and inpatient postoperative care.
Key payers in national coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers can expect an overview of the clinical context for use of the code, typical sites of service and care pathways, and the range of billing and coverage considerations relevant to major national payers. The publication will also outline commonly reported modifiers and note where input was not available.
This national-focused summary is intended for hospital billing departments, coding professionals, and policy analysts seeking concise clinical and billing context for 33924, including expected care setting and why proper coding matters for procedure classification, resource use, and inpatient surgical management.
Billing Code Overview
CPT code 33924 describes a surgical procedure to ligate and reestablish a connection between the systemic artery and the pulmonary artery after a prior operation created a shunt between those vessels. The procedure also includes a concurrent operative repair to correct a congenital cardiac anomaly.
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Service type: Open cardiothoracic surgery combining shunt revision and congenital heart defect repair
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Typical site of service: Inpatient hospital, cardiac surgery operating room and postoperative cardiac intensive care unit
Clinical & Coding Specifications
Clinical Context
A 6-month-old infant with a history of complex congenital heart disease presents for surgical reestablishment of a systemic-to-pulmonary artery connection after a previous palliative shunt. The child was born with a cyanotic lesion such as tetralogy of Fallot with pulmonary atresia or a single ventricle physiology requiring an aortopulmonary shunt (Blalock-Taussig type) placed in the neonatal period. Over time the original shunt has occluded or become inadequate, necessitating reoperation to ligate the old shunt, reestablish continuity between the systemic artery and pulmonary artery, and concurrently correct a native congenital cardiac anomaly (for example, repair of a ventricular septal defect or relief of right ventricular outflow tract obstruction).
Preoperative workflow includes multidisciplinary evaluation by pediatric cardiology, cardiac anesthesia assessment, echocardiography and cardiac catheterization as indicated, and informed consent discussing staged surgical palliation. In the operating room under general anesthesia and cardiopulmonary support as required, the surgeon performs median sternotomy or thoracotomy, identifies and ligates the prior shunt, constructs a new conduit or directly reestablishes the systemic–pulmonary connection, and performs the corrective intracardiac procedure. Postoperative care involves pediatric cardiac intensive care monitoring, ventilatory support as needed, inotropic management, chest tube care, and staged follow-up for subsequent procedures or definitive repair.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard claim submission | Use for routine, unmodified billing when no specific modifier applies |
11 | Principal physician of record | Use when reporting the primary surgeon who directed the case |
22 | Increased procedural services | Use when work exceeds typical effort (extensive additional cardiac repair) with documentation supporting unusual effort |
23 | Unusual anesthesia — patient condition | Use when the patient’s condition requires anesthesia that is medically contraindicated but provided due to circumstances (rare in pediatrics) |
26 | Professional component | Use if separate reporting of physician professional component is required for a component of intraoperative interpretation or consultation |
52 | Reduced services | Use when the planned procedure is partially reduced or not completed as planned |
53 | Discontinued procedure | Use when the procedure is started but terminated due to patient instability or intraoperative complication before completion |
62 | Two surgeons | Use when two surgeons work together as primary surgeons during complex congenital repair requiring splitting of operative responsibilities |
78 | Unplanned return to the operating room following initial procedure | Use when the patient returns to the OR for a related procedure during the global period due to a complication |
80 | Assistant surgeon | Use when a surgical assistant (not a co-surgeon) provides assistance and is eligible to bill |
81 | Minimum assistant surgeon | Use when a less experienced assistant provides limited assistance; follows payer rules |
82 | Assistant surgeon (when qualified resident not available) | Use when a qualified resident is not available and an assistant surgeon bills |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist | Use when an advanced practice clinician performs or assists in parts of the procedure per payer rules |
63 | Procedure performed on infants less than 4 kg | Use for neonatal/small-infant cases where payers recognize increased complexity due to size |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RP0000X | Pediatric Cardiac Surgeon | Primary specialty performing complex congenital heart operations |
207RC0000X | Cardiothoracic Surgeon | Adult/pediatric cardiothoracic surgeons who perform shunt revisions and intracardiac repairs |
207K00000X | Pediatric Cardiology | Preoperative evaluation, intraoperative consultation, and postoperative management |
363L00000X | Cardiac Anesthesiology | Provides pediatric cardiac anesthesia and perioperative hemodynamic management |
208000000X | Critical Care Medicine | Pediatric cardiac intensivists responsible for postoperative ICU care |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Q21.3 | Tetralogy of Fallot | Common cyanotic congenital heart defect that often requires systemic–pulmonary shunt or staged repair |
Q21.1 | Pulmonary valve atresia and stenosis | Lesions that may be palliated with a systemic–pulmonary shunt when pulmonary blood flow is inadequate |
Q20.0 | Common arterial trunk | Major congenital anomaly sometimes requiring staged surgical interventions including shunts and reconstruction |
Q21.0 | Ventricular septal defect | Intracardiac defect commonly repaired during the same operative setting as shunt revision |
Q22.3 | Hypoplasia of pulmonary artery | Pulmonary artery underdevelopment requiring reconstruction when reestablishing pulmonary blood flow |
Q22.2 | Stenosis of pulmonary artery | Can necessitate patch augmentation or reconstruction during shunt reestablishment |
Z98.890 | Other specified postprocedural states | Used to indicate prior shunt placement and need for reoperation in postprocedural context |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
33924 | Ligation of systemic artery to pulmonary artery shunt with reestablishment of systemic–pulmonary continuity; with repair of congenital cardiac anomaly | Primary procedure: ligation and reestablishment of shunt plus concurrent congenital heart repair |
33405 | Reconstruction of great vessel (arterial) — includes repair or reconstruction of pulmonary artery branches | May be performed when pulmonary artery reconstruction or patch augmentation is needed during shunt revision |
33210 | Insertion of temporary transvenous pacemaker (emergency) | May be used perioperatively for arrhythmia management or hemodynamic support during complex infant cardiac surgery |
33860 | Repair of congenital cardiac septal defect with cardiopulmonary bypass | Often performed alongside shunt revision when definitive repair of intracardiac defects (e.g., VSD) is undertaken |
99291 | Critical care, evaluation and management of the critically ill or injured patient, first 30-74 minutes | Used by critical care physicians for postoperative ICU critical care services following complex congenital cardiac surgery |