Summary & Overview
CPT 33964: Reposition Central Cannula for Extracorporeal Circulation, Pediatric
CPT code 33964 represents the open surgical repositioning of a central cannula for extracorporeal circulation in children aged six years and older, performed via sternotomy or thoracotomy with fluoroscopic guidance. This procedure is an important cardiac surgical service for pediatric patients requiring modification of cannulation for cardiopulmonary support. Nationally, accurate coding of such high-complexity surgical interventions affects claims adjudication, resource allocation in tertiary pediatric centers, and comparative procedure utilization metrics.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides readers with benchmark considerations, the clinical context for when this procedure is performed, and the typical site-of-service expectations for billing and reimbursement workflows. It also outlines common modifiers and data availability where provided. Data not available in the input is noted explicitly.
Readers will learn: the clinical scope and coding definition of CPT code 33964; which payers are typically involved in coverage decisions; typical sites of service and service type; and which elements of supporting data are present or missing. This briefing is intended for billing managers, clinical coders, health policy analysts, and hospital revenue cycle teams seeking a concise, national-level overview of this specific pediatric cardiac surgical code.
Billing Code Overview
CPT code 33964 describes the repositioning of a central cannula for extracorporeal circulation through an open surgical approach (sternotomy or thoracotomy) in a child aged six years or older. The procedure includes the use of fluoroscopic guidance.
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Service type: Open surgical repositioning of a central extracorporeal cannula in a pediatric patient (≥6 years).
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Typical site of service: Inpatient operating room or surgical suite via sternotomy or thoracotomy.
Clinical & Coding Specifications
Clinical Context
A 9-year-old child with congenital heart disease is scheduled for surgical repositioning of a central cannula used for extracorporeal circulation. The patient previously underwent cannulation for cardiopulmonary bypass and now presents with malposition of the central cannula identified on postoperative chest radiograph and confirmed by intraoperative fluoroscopy. The clinical workflow begins with preoperative assessment by pediatric cardiothoracic surgery and anesthesia, review of prior operative notes and imaging, and confirmation of informed consent. In the operating room under general endotracheal anesthesia, the surgical team performs a sternotomy or reopens a prior thoracotomy incision to expose the mediastinum. Fluoroscopic guidance is used intraoperatively to visualize cannula tip position and guide manipulation. The surgeon repositions the central cannula to optimize venous drainage and ensure safe extracorporeal circulation. Intraoperative transesophageal echocardiography or fluoroscopy may confirm final placement. Postoperative care includes monitoring in the pediatric intensive care unit for hemodynamic stability, chest tube management, anticoagulation management as indicated, and serial imaging to confirm cannula position and function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier specified by payer (placeholder) | Rarely used; some payers require an absence identifier when no other modifier applies |