Basics of CPT code 33900, 33901, 33902, 33903, 33904
CPT Code 33900, 33901, 33902, 33903, 33904 describe endovascular repair of pulmonary artery stenosis by stent placement. CPT Codes 33900, 33901 describe stent placement within the pulmonary arteries via normal native connections, defined as superior vena cava/inferior vena cava to right atrium, then right ventricle, then pulmonary arteries. CPT Codes 33902, 33903 describe stent placement within the pulmonary arteries, ductus arteriosus, or within a surgical shunt, via abnormal connections or through post-surgical shunts (eg, Blalock-Taussig shunt, Sano shunt, or post Glenn or Fontan procedures).
CPT Code 33904 is an add-on code that describes placement of stent(s) in additional vessels or lesions beyond the primary vessel or lesion treated whether access is via normal or abnormal connection.
CPT Codes 33900, 33901, 33902, 33903, 33904 include vascular access and all catheter and guidewire manipulation, fluoroscopy to guide the intervention, any post-diagnostic angiography for roadmapping purposes and post-implant evaluation, stent positioning and balloon inflation for stent delivery, and radiologic supervision and interpretation of the intervention. Angiography at the same session, as part of a diagnostic cardiac catheterization, may be reported with the appropriate angiographic codes from the Radiology or Medicine/Cardiovascular/Cardiac Catheterization/Injection Procedures sections.
CPT Code 33904 is an add-on code that describes placement of stent(s) in additional vessels or lesions beyond the primary vessel or lesion treated whether access is via normal or abnormal connection.
CPT Codes 33900, 33901, 33902, 33903, 33904 include vascular access and all catheter and guidewire manipulation, fluoroscopy to guide the intervention, any post-diagnostic angiography for roadmapping purposes and post-implant evaluation, stent positioning and balloon inflation for stent delivery, and radiologic supervision and interpretation of the intervention. Angiography at the same session, as part of a diagnostic cardiac catheterization, may be reported with the appropriate angiographic codes from the Radiology or Medicine/Cardiovascular/Cardiac Catheterization/Injection Procedures sections.
Diagnostic cardiac catheterization and diagnostic angiography codes (93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93563, 93566, 93567, 93568, 93593, 93594, 93596, 93597, 93598) should not be used with 33900, 33901, 33902, 33903, 33904 to report:
1. Contrast injections, angiography, roadmapping, and/or fluoroscopic guidance for the TPVI,
2. Pulmonary conduit angiography for guidance of TPVI, or
3. Right heart catheterization for hemodynamic measurements before, during, and after TPVI for guidance of TPVI.
Diagnostic right and left heart catheterization codes (93451, 93452, 93453, 93456, 93457, 93458, 93459, 93460, 93461, 93593, 93594, 93595, 93596, 93597, 93598), diagnostic coronary angiography codes (93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93563, 93564), and diagnostic angiography codes 93565, 93566, 93567, 93568 may be separately reported in conjunction with 33900, 33901, 33902, 33903, 33904, representing separate and distinct services from pulmonary artery revascularization, if:
1. No prior study is available and a full diagnostic study is performed, or
2. A prior study is available, but as documented in the medical record:
a. There is inadequate visualization of the anatomy and/or pathology, or
b. The patient’s condition with respect to the clinical indication has changed since the prior study, or
c. There is a clinical change during the procedure that requires new evaluation.
Balloon angioplasty (92997, 92998) within the same target lesion as stent implant, either before or after stent deployment, is not separately reported.
For balloon angioplasty at the same session as 33900, 33901, 33902, 33903, 33904, but for a distinct lesion or in a different artery, use CPT code 92997, 92998.
To report percutaneous pulmonary artery revascularization by stent placement in conjunction with diagnostic congenital cardiac catheterization, use CPT code 33900, 33901, 33902, 33903, 33904
For transcatheter intracardiac shunt (TIS) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, use CPT code 33745, 33746.
Description of CPT code 33900, 33901, 33902, 33903, 33904
Stenotic lesions of the pulmonary artery that do not achieve good treatment results from balloon angioplasty can be managed using endovascular stents to provide a more rigid structure to support the vessel. The stenotic lesions are treated under general anesthesia using fluoroscopic guidance during a separately reportable right and/or left heart cardiac catheterization for congenital defects. Vascular access, typically though a large vein, will vary due to patient anatomy.
Lidocaine is applied to the access site, which is punctured, and a guidewire and introducer sheath are placed in the vein. A catheter is advanced over the wire to the target area. Diagnostic angiograms are first done to measure the stenotic lesion and neighboring vessels, after which the appropriate size stent and balloon are selected. The angiogram catheter is exchanged for an end-hole catheter with soft guidewire, which is advanced just beyond the lesion.
The soft guidewire is replaced by a stiffer, interventional guidewire. The stent is prepared and mounted on the delivery balloon. The introducer sheath in the vein is exchanged for a delivery sheath, which is advanced over the stiff wire to the target area just past the pulmonary artery lesion. The stent on the delivery device is advanced to the tip of the delivery sheath. When the stent is positioned across the lesion, the delivery sheath is withdrawn partway to perform an angiogram for position verification.
Any adjustments are made and visualized again until placement is optimal. The sheath is withdrawn completely and the balloon is deployed to deliver the stent. The delivery balloon is removed and a larger pressure balloon may be advanced over the wire and inflated to dilate the stent to the appropriate diameter. A diagnostic catheter is exchanged for the balloon to assess the result, stent position, and any need for further intervention. Instruments are removed and hemostasis is maintained.
CPT code 33900 is reported for unilateral and CPT code 33901 for bilateral initial stent placement in the pulmonary artery with venous access through normal native right heart structures and chambers. CPT code 33902 or 33903 is reported for similar stent placement in the pulmonary arteries, ductus arteriosus, or surgical shunt through abnormal connections, or surgically corrected anatomy, such as a through a Blalock-Taussig shunt, or Glenn or Fontan repairs. CPT Code 33904 is reported for each additional stent placed through either normal or abnormal connections.
33900 Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, unilateral
33901 normal native connections, bilateral
33902 abnormal connections, unilateral
33903 abnormal connections, bilateral
33904 Percutaneous pulmonary artery revascularization by stent placement, each additional vessel or separate lesion, normal or abnormal connections (List separately in addition to code for primary procedure)
Coding tip for CPT code 36836 & 36837
Codes 36836, 36837 describe percutaneous arteriovenous fistula creation in the upper extremity for hemodialysis access, including image-guided percutaneous access into a peripheral artery and peripheral vein via single access (36836) or two separate access sites (36837). The artery and vein are approximated and then energy (eg, thermal) is applied to establish the fistulous communication between the two vessels. Fistula maturation procedures promote blood flow through the newly created fistula by augmentation (eg, angioplasty) or redirection (eg, coil embolization of collateral pathways) of blood flow. Codes 36836, 36837 include all vascular access, angiography, imaging guidance, and blood flow redirection or maturation techniques (eg, transluminal balloon angioplasty, coil embolization) performed for fistula creation. These procedures may not be reported separately with 36836, 36837, when performed at the same operative session.
The WavelinQ™ EndoAVF System utilizes percutaneously placed magnetized catheters to localize and facilitate AV fistula creation using RF energy. Effective January 2023, hospitals and physicians report code 36837 for the entire WavelinQ™ procedure. This procedure is currently reimbursed when performed in the hospital or ASC locations. Code 36837 has dropped the terminology from prior HCPCS Level II code G2171 concerning magnets, and it now refers to separate placement of two access sites for arterial and venous catheter placements in the upper extremities.
Procedures described by CPT codes 36836 and 36837 include use of RF or thermal energy to fuse the artery and vein (without sutures), any imaging to guide access to the vessels (ultrasound), IVUS, all catheter placements, all contrast venography and angiography, radiologic S&I, balloon angioplasty and/or stent placement, embolization of branches to facilitate maturation of the fistula, and any other fistula maturation procedures to redirect and improve blood flow through the fistula. See parentheticals for procedure codes not to report with percutaneous dialysis fistula creation
36836 Percutaneous arteriovenous fistula creation, upper extremity, single access of both the peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation
36837 Percutaneous arteriovenous fistula creation, upper extremity, separate access sites of the peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation
Revised CPT code
35883 Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with nonautogenous patch graft (eg, polyester, ePTFE, bovine pericardium)
For bilateral procedure, use modifier 50 with code 35883.
Do and Don’t
Do not report CPT code 33900, 33901, 33902, 33903, 33904 in conjunction with 76000, 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93563, 93564, 93565, 93566, 93567, 93568, 93593, 93594, 93596, 93597, 93598 for catheterization and angiography services intrinsic to the procedure.
Do use CPT code 33904 in conjunction with code 33900, 33901, 33902, 33903
Do not report CPT code 36836 & 36837 in conjunction with 36005, 36140, 36215, 36216, 36217, 36218, 36245, 36246, 36247, 36837, 36901, 36902, 36903, 36904, 36905, 36906, 36907, 36908, 36909, 37236, 37238, 37241, 37242, 37246, 37248, 37252, 75710, 75716, 75820, 75822, 75894, 75898, 76937, 77001
For arteriovenous fistula creation via an open approach, use CPT code 36800, 36810, 36815, 36818, 36819, 36820, 36821
For percutaneous arteriovenous fistula creation in any location other than the upper extremity, use CPT code 37799
Do not report 35883 in conjunction with 35700, 35875, 35876, 35884
Additional Code Information for CPT code 33900, 33901, 33902, 33903, 33904
PC/TC Indicator (26): 0 = Physician Service Codes
Multiple Procedures (51): 2 = Standard payment adjustment rules for multiple procedures apply
Physician Supervision: 09 = Concept does not apply
Assistant Surgeon (80,82): 0 = Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted
Co-Surgeons (62): 0 = Co-surgeons not permitted for this procedure
Team Surgery (66): 0 = Team surgeons not permitted for this procedure
Diagnostic Imaging Family: 99 = Concept does not apply
Additional Code Information for CPT code 36836 & 36837
PC/TC Indicator (26): 0 = Physician Service Codes
Multiple Procedures (51): 2 = Standard payment adjustment rules for multiple procedures apply
Bilateral Surgery (50): 0 = 150% payment adjustment for bilateral procedures does not apply
Physician Supervision: 09 = Concept does not apply
Assistant Surgeon (80,82): 2 = Payment restriction for assistants at surgery does not apply to this procedure
Co-Surgeons (62): 1 = Co-surgeons could be paid, though supporting documentation is required
Team Surgery (66): 0 = Team surgeons not permitted for this procedure
Diagnostic Imaging Family: 99 = Concept does not apply
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