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Official Description

Valvuloplasty, mitral valve, with cardiopulmonary bypass;

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

Mitral valvuloplasty is a surgical procedure aimed at correcting issues with the mitral valve, which is situated between the left atrium and the left ventricle of the heart. This procedure is primarily indicated for patients suffering from mitral valve prolapse and regurgitation. Mitral valve prolapse occurs when the valve leaflets bulge upward into the left atrium during the contraction of the left ventricle, leading to improper closure of the valve. As a result, blood can leak back into the left atrium, a condition known as regurgitation. The surgical approach typically involves exposing the heart through a median sternotomy or a right anterolateral thoracotomy, allowing access to the mitral valve. During the procedure, cardiopulmonary bypass is established to maintain circulation and oxygenation of the blood while the heart is temporarily stopped. The surgical team initiates cardioplegia to protect the heart muscle during the operation. An incision is made in the left atrium to expose the mitral valve, and the specific repair technique employed will depend on the nature and severity of the valve's damage or malformation. Various methods, such as annuloplasty or leaflet repair, may be utilized to restore the valve's function and integrity, ensuring that it closes properly and prevents regurgitation.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The mitral valvuloplasty procedure is indicated for the following conditions:

  • Mitral Valve Prolapse - A condition where the mitral valve leaflets bulge into the left atrium during heart contraction, potentially leading to regurgitation.
  • Mitral Regurgitation - Occurs when the mitral valve does not close tightly, allowing blood to flow backward into the left atrium, which can lead to heart failure and other complications.

2. Procedure

The mitral valvuloplasty procedure involves several critical steps to ensure effective repair of the mitral valve:

  • Step 1: Accessing the Heart - The procedure begins with the patient being placed under general anesthesia. A median sternotomy or right anterolateral thoracotomy is performed to gain access to the heart. This surgical approach allows the surgeon to visualize and operate on the mitral valve directly.
  • Step 2: Establishing Cardiopulmonary Bypass - Once access is achieved, cardiopulmonary bypass is initiated. This involves diverting blood away from the heart and lungs, allowing the surgeon to operate on a still and bloodless field. Cardioplegia is administered to induce temporary cardiac arrest and protect the heart muscle during the procedure.
  • Step 3: Exposing the Mitral Valve - An incision is made in the left atrium to expose the mitral valve. This step is crucial for assessing the condition of the valve and determining the appropriate repair technique.
  • Step 4: Repairing the Mitral Valve - The type of repair performed is based on the specific damage or malformation of the valve. If the valve annulus is dilated, an annuloplasty may be performed, which involves plicating the edges of the valve to reduce the size of the orifice. If a ring annuloplasty device is utilized, the annulus is sized, and a suitable ring is placed and secured with sutures. Additionally, if the valve leaflets are damaged, they may be repaired using an autologous pericardial patch. In cases where the chordae tendineae are ruptured or elongated, they may be resected, followed by plication to narrow the valve diameter and reconstruct the valve leaflet. If the chordae are broken, they can be replaced with special sutures, and other techniques such as transfer or transposition of chordae from one leaflet to another may also be employed.
  • Step 5: Closing the Incision - After the repair is completed, the heart incision is closed, and the patient is gradually weaned off cardiopulmonary bypass. Chest tubes may be placed as necessary to drain any excess fluid, and the chest is then closed securely.

3. Post-Procedure

Following the mitral valvuloplasty procedure, patients are typically monitored in a recovery area for any complications. The expected recovery period may vary depending on the individual’s overall health and the complexity of the surgery. Patients may require pain management and will be monitored for signs of infection or other postoperative complications. Follow-up appointments are essential to assess the function of the repaired mitral valve and to ensure that the patient is recovering appropriately. Rehabilitation may also be recommended to help the patient regain strength and improve cardiovascular health.

Short Descr REPAIR OF MITRAL VALVE
Medium Descr VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS
Long Descr Valvuloplasty, mitral valve, with cardiopulmonary bypass;
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)
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
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.
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).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient 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).
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).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
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.
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).
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).
AG Primary physician
ET Emergency services
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
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
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2010-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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