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Transcatheter aortic valve replacement (TAVR/TAVI) is a minimally invasive procedure designed to treat aortic stenosis, a condition characterized by the narrowing of the aortic valve, which can lead to significant heart complications. During this procedure, a diseased aortic valve is replaced with a prosthetic valve, allowing for improved blood flow and heart function. The TAVR/TAVI procedure is particularly beneficial for patients who may be at high risk for traditional open-heart surgery due to age, comorbidities, or other health factors. When TAVR/TAVI is performed with the support of cardiopulmonary bypass (CPB), it involves the use of specialized cannulas to connect the patient’s vascular system to a heart-lung machine, which temporarily takes over the function of the heart and lungs during the procedure. This support is crucial for maintaining blood circulation and oxygenation while the aortic valve is being replaced. The use of percutaneous peripheral arterial and venous cannulation, typically through the femoral vessels, is a common approach to establish CPB, although alternative methods may be employed based on the patient's vascular anatomy. The procedure is complex and requires careful planning and execution to ensure patient safety and optimal outcomes.
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Transcatheter aortic valve replacement (TAVR/TAVI) 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. TAVR/TAVI is particularly suitable for patients who are considered high-risk for traditional surgical aortic valve replacement due to factors such as advanced age, multiple comorbidities, or other health complications that may complicate recovery from open-heart surgery.
The TAVR/TAVI procedure involves several critical steps to ensure successful valve replacement. First, the patient is prepared for the procedure, which includes administering anesthesia and establishing intravenous access. The next step involves the insertion of a venous cannula into the right atrial appendage and an arterial cannula into the ascending aorta to facilitate cardiopulmonary bypass (CPB). A cardioplegia cannula is then placed in the coronary sinus through a stab incision in the right atrium, and a second cannula is positioned in the ascending aorta. Additionally, a left ventricular vent is placed in the right superior pulmonary vein to assist in managing the heart's function during the procedure. Once all cannulas are in place, CPB is established, and cardioplegic arrest is initiated to protect the heart during valve replacement. Following this, the TAVR/TAVI is performed, which involves the careful placement of the prosthetic valve within the diseased aortic valve. After the valve is successfully implanted, the patient is gradually weaned off bypass support. Finally, chest tubes may be placed as necessary to drain any excess fluid, and the chest incision is closed to complete the procedure.
After the TAVR/TAVI procedure, patients are monitored closely for any complications related to the surgery or the cardiopulmonary bypass. Recovery typically involves a stay in the intensive care unit (ICU) for observation, followed by transfer to a regular hospital room. Patients may require pain management and monitoring for signs of infection or bleeding. The placement of chest tubes may be necessary to drain fluid accumulation, and these will be removed once the patient is stable. The overall recovery time can vary, but many patients experience significant improvement in symptoms related to aortic stenosis shortly after the procedure. Follow-up appointments are essential to assess the function of the new valve and to monitor the patient's overall cardiovascular health.
| Short Descr | REPLACE AORTIC VALVE W/BYP | Medium Descr | REPLACE AORTIC VALVE W/BYP PRQ ART/VENOUS APPRCH | Long Descr | 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) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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) | 0 - Co-surgeons not permitted for this procedure. | 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) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 43 - Heart valve procedures |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 0483T | MPFS Status: Carrier Priced APC C Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve; percutaneous approach, including transseptal puncture, when performed | 0484T | MPFS Status: Carrier Priced APC C Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve; transthoracic exposure (eg, thoracotomy, transapical) | 0544T | MPFS Status: Carrier Priced APC C Transcatheter mitral valve annulus reconstruction, with implantation of adjustable annulus reconstruction device, percutaneous approach including transseptal puncture | 0545T | MPFS Status: Carrier Priced APC C Transcatheter tricuspid valve annulus reconstruction with implantation of adjustable annulus reconstruction device, percutaneous approach | 0569T | MPFS Status: Carrier Priced APC C Transcatheter tricuspid valve repair, percutaneous approach; initial prosthesis | 0570T | Add-on Code MPFS Status: Carrier Priced APC C Transcatheter tricuspid valve repair, percutaneous approach; each additional prosthesis during same session (List separately in addition to code for primary procedure) | 0643T | Resequenced code MPFS Status: Carrier Priced APC C Transcatheter left ventricular restoration device implantation including right and left heart catheterization and left ventriculography when performed, arterial approach | 0644T | MPFS Status: Carrier Priced APC J1 ASC J8 Transcatheter removal or debulking of intracardiac mass (eg, vegetations, thrombus) via suction (eg, vacuum, aspiration) device, percutaneous approach, with intraoperative reinfusion of aspirated blood, including imaging guidance, when performed | 33361 | MPFS Status: Active Code APC C Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach | 33362 | MPFS Status: Active Code APC C Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach | 33363 | MPFS Status: Active Code APC C Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach | 33364 | MPFS Status: Active Code APC C Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach | 33365 | MPFS Status: Active Code APC C Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy) | 33366 | MPFS Status: Active Code APC C Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical exposure (eg, left thoracotomy) | 33418 | MPFS Status: Active Code APC C Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis | 33477 | MPFS Status: Active Code APC C Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed | 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) |
| 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. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study |
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| 2013-01-01 | Added | Added |
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