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Transcatheter aortic valve replacement (TAVR/TAVI) is a minimally invasive surgical procedure designed to replace a stenotic (narrowed) aortic heart valve with a prosthetic valve. This procedure is performed through a transapical approach, which involves accessing the heart via a left thoracotomy and a stab incision at the apex of the heart. The left thoracotomy is typically performed at the sixth intercostal space, allowing the surgeon to reach the heart effectively. During the procedure, the pericardium, the protective sac surrounding the heart, is opened to gain access to the left ventricle. A needle puncture is made to enter the left ventricle, and this opening is gradually dilated to accommodate the introduction of a valve delivery catheter. The catheter is then carefully threaded over a guidewire, navigating through the left ventricle to the native aortic valve. To ensure proper pacing of the heart during the valve delivery, epicardial pacing wires may be placed on the left ventricle as needed. Prior to the placement of the prosthetic valve, the native aortic valve may be dilated using a balloon catheter to facilitate the deployment of the new valve. The compressed prosthetic valve, contained within a valve cage, is advanced over the guidewire to the site of the native aortic valve. Once positioned correctly, the valve is deployed, and the valve cage is subsequently removed. A balloon tip catheter is then utilized to properly seat the aortic valve by inflating it within the prosthetic valve. After confirming the position and function of the newly placed valve, the catheter is withdrawn, and the transapical puncture site, along with the chest incisions, are closed with sutures, completing the procedure.
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The transcatheter aortic valve replacement (TAVR/TAVI) procedure is indicated for patients with aortic stenosis, which is characterized by the narrowing of the aortic valve opening, leading to reduced blood flow from the heart. This condition can result in symptoms such as shortness of breath, chest pain, fatigue, and syncope (fainting). TAVR is typically recommended for patients who are considered high-risk or inoperable for traditional open-heart surgery due to various factors, including advanced age, comorbidities, or other health complications that may complicate recovery from more invasive surgical procedures.
The TAVR procedure involves several critical steps to ensure successful valve replacement. Initially, a limited anterolateral left thoracotomy is performed at the sixth intercostal space to access the apex of the heart. This incision allows the surgeon to reach the left ventricle directly. Following this, the pericardium is opened to expose the heart, and a needle puncture is made to enter the left ventricle. This puncture is then serially dilated to create an adequate opening for the valve delivery catheter. Once the opening is sufficiently enlarged, the catheter is threaded over a guidewire and navigated through the left ventricle to the native aortic valve. To facilitate the procedure, epicardial pacing wires may be placed on the left ventricle to control the heart's rhythm during valve deployment. Prior to the introduction of the prosthetic valve, the native aortic valve may be dilated using a balloon catheter to ensure proper fit and positioning of the new valve. The catheter containing the compressed prosthetic valve, which is housed within a valve cage, is then advanced over the guidewire to the site of the native aortic valve. The compressed valve is positioned accurately within the diseased aortic valve and deployed. After deployment, the valve cage is removed, and a balloon tip catheter is used to inflate the prosthetic valve, ensuring it is seated correctly. The position and function of the newly placed valve are verified to confirm successful placement. Finally, the catheter is withdrawn, and the transapical puncture site, along with the chest incisions, are closed with sutures to complete the procedure.
After the TAVR procedure, patients are typically monitored in a recovery area for any immediate complications. Post-procedure care may include managing pain, monitoring vital signs, and ensuring the patient is stable. Patients may require additional imaging studies to assess the position and function of the newly implanted valve. Recovery time can vary, but many patients experience a shorter hospital stay compared to traditional surgical valve replacement. Follow-up appointments are essential to monitor the patient's progress and to manage any potential complications, such as valve dysfunction or infection at the incision sites. Patients are also advised on activity restrictions and medication management to support their recovery and overall heart health.
| Short Descr | TRCATH REPLACE AORTIC VALVE | Medium Descr | TRANSCATHETER TRANSAPICAL REPLACEMT AORTIC VALVE | Long Descr | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical exposure (eg, left thoracotomy) | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | 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 Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | Team Surgery (66) | 1 - Team surgeons could be paid, though... | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2B - Major procedure, cardiovascular-Aneurysm repair | MUE | 1 |
This is a primary code that can be used with these additional add-on codes.
| 33367 | Addon Code MPFS Status: Active Code APC C Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation (eg, femoral vessels) (List separately in addition to code for primary procedure) | 33368 | Addon Code MPFS Status: Active Code APC C Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (eg, femoral, iliac, axillary vessels) (List separately in addition to code for primary procedure) | 33369 | Addon Code MPFS Status: Active Code APC C Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with central arterial and venous cannulation (eg, aorta, right atrium, pulmonary artery) (List separately in addition to code for primary procedure) | 33370 | Add-on Code MPFS Status: Active Code APC N Transcatheter placement and subsequent removal of cerebral embolic protection device(s), including arterial access, catheterization, imaging, and radiological supervision and interpretation, percutaneous (List separately in addition to code for primary procedure) | 37252 | Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) | 37253 | Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (List separately in addition to code for primary procedure) | 93568 | Addon Code MPFS Status: Active Code APC N ASC N1 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for nonselective pulmonary arterial angiography (List separately in addition to code for primary procedure) | 93569 | Add-on Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, unilateral (List separately in addition to code for primary procedure) | 93573 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, bilateral (List separately in addition to code for primary procedure) | 93574 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary venous angiography of each distinct pulmonary vein during cardiac catheterization (List separately in addition to code for primary procedure) | 93575 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary angiography of major aortopulmonary collateral arteries (MAPCAs) arising off the aorta or its systemic branches, during cardiac catheterization for congenital heart defects, each distinct vessel (List separately in addition to code for primary procedure) | 93662 | Addon Code MPFS Status: Carrier Priced APC N PUB 100 CPT Assistant Article Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure) |
| 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 66 | Surgical team: under some circumstances, highly complex procedures (requiring the concomitant services of several physicians or other qualified health care professionals, often of different specialties, plus other highly skilled, specially trained personnel, various types of complex equipment) are carried out under the "surgical team" concept. such circumstances may be identified by each participating individual with the addition of modifier 66 to the basic procedure number used for reporting services. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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