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"Patient with a history of pulmonary stenosis, prior balloon valvuloplasty x2, and failed transcatheter valve placement. PROCEDURES: 1) RHC. 2) Angiography: RVOT and branch pulmonary arteries. 3) Hybrid, transapical, transcatheter pulmonary valve replacement. Subxiphoid midline incision performed, exposing the RV apex, pursestring suture placed. 18 gauge needle advanced through the suture and through the RV free wall into the RV cavity. Guidewire positioned in the ventricle and needle exchanged for a short sheath. Positioned a guidewire in the distal LPA. Transaortic Edwards delivery sheath positioned in mid RV. Sizing balloon used and then an S3 valve advanced over the guidewire and through the sheath and across the RVOT. Valve deployed. The guidewire and sheath were removed and the pursestring suture tightened, repairing the RV free wall access site. A mediastinal drain was placed." Should we use 33477 or 93799 because of the hybrid transapical approach? Any other recommendations?