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The procedure described by CPT® Code 33413 involves the replacement of the aortic valve through a surgical technique known as the Ross procedure. In this complex operation, the patient's own pulmonary valve is translocated to replace the diseased aortic valve, while a pulmonary valve allograft, sourced from a deceased donor, is used to replace the patient's original pulmonary valve. This innovative approach is primarily indicated for patients suffering from aortic stenosis, a condition characterized by the narrowing of the aortic valve opening, which can lead to significant heart complications if left untreated. The surgical access is achieved by performing a sternotomy, which involves opening the sternum to gain direct access to the heart. To facilitate the procedure and ensure the heart remains functional during surgery, cardiopulmonary bypass is initiated. This allows for the temporary diversion of blood away from the heart and lungs, enabling the surgeon to operate on a still and bloodless field. The aorta is then incised, and the stenotic aortic valve leaflets are carefully excised, with particular attention paid to preserving the coronary arteries. Following the excision, the aortic valve annulus is meticulously prepared to accommodate the translocated pulmonary valve, which is harvested from the patient and sutured into place. Subsequently, the pulmonary valve annulus is prepared for the implantation of the allograft pulmonary valve, which is also sutured into position. Once the procedure is complete, cardiopulmonary bypass is discontinued, and chest tubes may be placed as necessary to facilitate drainage. Finally, the chest is closed, marking the conclusion of the surgical intervention.
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The Ross procedure, as described by CPT® Code 33413, is indicated for patients with aortic stenosis, a condition where the aortic valve becomes narrowed, impeding blood flow from the heart to the rest of the body. This procedure is particularly suitable for individuals who may benefit from the unique advantages of using their own pulmonary valve, which can provide a more favorable long-term outcome compared to mechanical or other types of prosthetic valves.
The surgical steps involved in the Ross procedure are as follows:
Post-procedure care following the Ross procedure includes monitoring the patient for any complications related to the surgery, such as bleeding or infection. Patients may require a stay in the intensive care unit (ICU) for close observation immediately after surgery. Pain management will be provided, and the surgical site will be monitored for signs of healing. Patients are typically advised on activity restrictions during the recovery period to allow for proper healing of the chest and heart. Follow-up appointments will be necessary to assess the function of the newly placed valves and to ensure that the patient is recovering as expected.
| Short Descr | REPLACEMENT OF AORTIC VALVE | Medium Descr | REPLACEMENT AORTIC&PULMON VALVES ROSS PROCEDUR | Long Descr | Replacement, aortic valve; by translocation of autologous pulmonary valve with allograft replacement of pulmonary valve (Ross procedure) | Status Code | Active Code | Global Days | 090 - Major Surgery | 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | 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 a primary code that can be used with these additional add-on codes.
| 33141 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting PUB 100 CPT Assistant Article Transmyocardial laser revascularization, by thoracotomy; performed at the time of other open cardiac procedure(s) (List separately in addition to code for primary procedure) | 33257 | Addon Code MPFS Status: Active Code APC C Illustration for Code Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), limited (eg, modified maze procedure) (List separately in addition to code for primary procedure) | 33259 | Addon Code MPFS Status: Active Code APC C Illustration for Code Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (eg, maze procedure), with cardiopulmonary bypass (List separately in addition to code for primary procedure) | 33530 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Reoperation, coronary artery bypass procedure or valve procedure, more than 1 month after original operation (List separately in addition to code for primary procedure) | 34714 | Addon Code MPFS Status: Active Code APC N ASC N1 Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition to code for primary procedure) | 34716 | Addon Code MPFS Status: Active Code APC N ASC N1 Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure) | 34833 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open iliac artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by abdominal or retroperitoneal incision, unilateral (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2002-01-01 | Changed | Code description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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