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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 prosthetic valve is inserted to replace the diseased valve, allowing for improved blood flow and heart function. The 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 equipment to temporarily take over the function of the heart and lungs, ensuring that blood is circulated and oxygenated while the surgical team works on the heart. This support is crucial in certain cases where the patient's vascular anatomy or body habitus complicates the procedure. The use of open peripheral arterial and venous cannulation, such as through the femoral, iliac, or axillary vessels, is a key aspect of establishing CPB during TAVR/TAVI. This code (CPT® 33368) is specifically used to report the additional services provided during the procedure when CPB is utilized, ensuring that all aspects of the surgical intervention are accurately captured for billing and documentation purposes.
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Aortic Stenosis The primary indication for transcatheter aortic valve replacement (TAVR/TAVI) is the presence of aortic stenosis, a condition where the aortic valve becomes narrowed, impeding blood flow from the heart to the rest of the body. This can lead to symptoms such as shortness of breath, chest pain, and fatigue.
High Surgical Risk TAVR/TAVI is indicated for patients who are considered high risk for traditional open-heart surgery due to factors such as advanced age, comorbidities, or other health complications that may increase the risk of surgical intervention.
Step 1: Patient Preparation Prior to the procedure, the patient undergoes a thorough evaluation, including imaging studies and assessments of their overall health status. This ensures that the patient is a suitable candidate for TAVR/TAVI and that any potential risks are identified.
Step 2: Cannulation for Cardiopulmonary Bypass The procedure begins with the establishment of cardiopulmonary bypass (CPB). A venous cannula is inserted into the right atrial appendage to drain deoxygenated blood, while an arterial cannula is placed in the ascending aorta to deliver oxygenated blood back to the body. Additionally, a cardioplegia cannula is placed in the coronary sinus via a stab incision in the right atrium to provide cardioplegic solution, and a left ventricular vent is positioned in the right superior pulmonary vein to facilitate drainage of the left ventricle.
Step 3: Initiation of Cardiopulmonary Bypass Once the cannulation is complete, CPB is established, and cardioplegic arrest is initiated. This process temporarily halts the heart's activity, allowing the surgical team to perform the valve replacement safely.
Step 4: Transcatheter Aortic Valve Replacement With the heart under cardioplegic arrest, the TAVR/TAVI procedure is performed. The prosthetic valve is carefully positioned and deployed within the native aortic valve, effectively replacing it and restoring normal blood flow.
Step 5: Weaning Off Bypass After the TAVR/TAVI procedure is completed, the patient is gradually weaned off cardiopulmonary bypass. This involves carefully monitoring the heart's function and ensuring that it can maintain adequate circulation independently.
Step 6: Post-Procedure Care Following the procedure, chest tubes may be placed as needed to drain any excess fluid or blood from the chest cavity. The chest incision is then closed, and the patient is monitored closely during the recovery phase to assess for any complications and ensure a smooth recovery.
After the completion of the TAVR/TAVI procedure with cardiopulmonary bypass support, patients typically require close monitoring in a recovery unit. The expected recovery period may vary based on individual patient factors, but generally, patients are observed for signs of complications such as bleeding, infection, or issues related to the prosthetic valve. Follow-up care is essential to assess the function of the new valve and to manage any ongoing health concerns. Patients may also receive instructions regarding activity restrictions and medication management to support their recovery and overall heart health.
| Short Descr | REPLACE AORTIC VALVE W/BYP | Medium Descr | REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH | Long Descr | 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) | 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. | 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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