© Copyright 2025 American Medical Association. All rights reserved.
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 impede blood flow from the heart to the rest of the body. During this procedure, a prosthetic valve is implanted to replace the diseased valve, thereby restoring normal blood flow. The unique aspect of this procedure is that it is performed with the assistance of cardiopulmonary bypass (CPB), which temporarily takes over the function of the heart and lungs during the surgery. This is achieved through the insertion of cannulas into the patient's vascular system, specifically into the central arteries and veins, such as the aorta and right atrium. The use of CPB allows for a controlled environment in which the heart can be temporarily stopped, enabling the surgeon to perform the valve replacement with precision. The TAVR/TAVI procedure is reported separately from the CPB support, which is indicated by the use of CPT® code 33369. This code specifically refers to the central arterial and venous cannulation required for CPB during the TAVR/TAVI procedure, highlighting the complexity and the need for careful planning and execution in patients with varying vascular anatomies or body types.
© Copyright 2025 Coding Ahead. All rights reserved.
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, leading to reduced blood flow from the heart. This can result in symptoms such as shortness of breath, chest pain, and fatigue.
Step 1: Cannulation The procedure begins with the establishment of cardiopulmonary bypass (CPB). This involves the insertion of a venous cannula into the right atrial appendage to drain deoxygenated blood from the heart. An arterial cannula is then placed in the ascending aorta to deliver oxygenated blood back to the body. Additionally, a cardioplegia cannula is inserted into the coronary sinus through a stab incision in the right atrium to provide cardioplegic solution, which temporarily stops the heart, allowing for a controlled environment during the valve replacement.
Step 2: Establishing CPB Once the cannulas are in place, CPB is established. This process involves connecting the cannulas to a pump-oxygenator, which takes over the function of the heart and lungs. The patient is then placed in a state of cardioplegic arrest, ensuring that the heart remains still and blood flow is managed externally.
Step 3: Performing TAVR/TAVI With the heart in a state of arrest, the transcatheter aortic valve replacement is performed. The prosthetic valve is carefully positioned and deployed within the native aortic valve, effectively replacing it. This step is critical as it restores normal blood flow through the aortic valve.
Step 4: 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 resume its normal activity without assistance from the pump-oxygenator.
Step 5: Closure Following successful weaning from bypass, chest tubes may be placed as needed to drain any excess fluid or blood from the chest cavity. Finally, the chest incision is closed, completing the surgical procedure.
Post-procedure care involves monitoring the patient for any complications related to the surgery and ensuring that the heart is functioning properly after the TAVR/TAVI. Patients may require additional support in the form of medications to manage pain and prevent infection. The recovery process will vary based on individual patient factors, but careful follow-up is essential to assess the success of the valve replacement and the overall recovery of the patient.
| Short Descr | REPLACE AORTIC VALVE W/BYP | Medium Descr | REPLACE AORTA VALVE W/BYP CNTRL ART/VENOUS APRCH | Long Descr | 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) | 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) |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2013-01-01 | Added | Added |
Get instant expert-level medical coding assistance.