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The CPT® Code 33477 refers to the procedure of transcatheter pulmonary valve implantation performed via a percutaneous approach. This innovative technique is primarily utilized to address dysfunctions in the right ventricular outflow tract (RVOT), which can manifest as either stenosis (narrowing) or regurgitation (backward flow) in the conduit connecting the right ventricle to the pulmonary artery. Conditions that may necessitate this procedure include tetralogy of Fallot, both with and without a conduit, as well as cases involving failing pulmonic bioprosthetic valves, truncus arteriosus, pulmonary atresia with ventricular septal defects (VSD), and transposition of the great arteries accompanied by VSD and pulmonic stenosis. The procedure involves the use of a specialized delivery system that includes a balloon catheter designed to facilitate the implantation of the pulmonary valve. The valve is crimped and loaded into a polytetrafluoroethylene sheath, which is then introduced into the vascular system through a selected access site, such as the femoral vein, subclavian vein, or internal jugular vein. This minimally invasive approach allows for precise placement of the valve within the heart, significantly improving patient outcomes by restoring proper blood flow from the right ventricle to the pulmonary artery.
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The transcatheter pulmonary valve implantation procedure is indicated for patients experiencing dysfunction in the right ventricular outflow tract (RVOT). Specific conditions that warrant this intervention include:
The transcatheter pulmonary valve implantation procedure involves several critical steps to ensure successful valve placement. Initially, the access site is selected, which can be the femoral vein, subclavian vein, or internal jugular vein. A large bore needle is then inserted through the skin into the chosen vein to gain vascular access. Following this, a guidewire is introduced through the needle, and a catheter sheath is placed over the guidewire, allowing it to be threaded toward the heart under fluoroscopic guidance. To assess the anatomy and size of the RVOT and evaluate right ventricular function, angiography may be performed. If the procedure requires pre-stenting to reinforce the conduit, a stent is deployed using a balloon in balloon catheter over the guidewire, positioning it in the right pulmonary artery. Once the stent is secured, the stent delivery catheter is removed, and the valve delivery catheter is advanced over the guidewire to the predetermined location. The pulmonary valve is then delivered across the pre-stented or unstented outflow tract into the pulmonary artery. To confirm proper placement and function of the valve, angiography and/or intracardiac echocardiography is utilized. After the procedure, the catheter, guidewire, and needle are removed, and the access site is monitored for any signs of bleeding. Depending on the situation, a suture may be necessary for closure, and the area is subsequently covered with a dressing.
Post-procedure care for patients undergoing transcatheter pulmonary valve implantation includes monitoring the access site for bleeding and ensuring that the patient is stable. The healthcare team will observe the patient for any complications that may arise following the procedure. Depending on the individual case, additional imaging may be required to assess the function of the newly implanted valve. Patients may also need follow-up appointments to evaluate their recovery and the performance of the valve over time. It is essential to provide appropriate care instructions to the patient regarding activity restrictions and signs of potential complications that should prompt immediate medical attention.
| Short Descr | IMPLANT TCAT PULM VLV PERQ | Medium Descr | TCAT PULMONARY VALVE IMPLANTATION PRQ APPROACH | Long Descr | Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | 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) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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 |
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) | 33367 | Addon Code MPFS Status: Active Code APC C 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) | 33368 | Addon Code MPFS Status: Active Code APC C 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) | 33369 | Addon Code MPFS Status: Active Code APC C 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) | 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) | 33924 | Addon Code MPFS Status: Active Code APC C CPT Assistant Article Ligation and takedown of a systemic-to-pulmonary artery shunt, performed in conjunction with a congenital heart procedure (List separately in addition to code for primary procedure) | 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) | 93462 | Addon Code MPFS Status: Active Code APC N ASC N1 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure) | 93463 | Addon Code MPFS Status: Active Code APC N Pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed (List separately in addition to code for primary procedure) | 93464 | Addon Code MPFS Status: Active Code APC N Physiologic exercise study (eg, bicycle or arm ergometry) including assessing hemodynamic measurements before and after (List separately in addition to code for primary procedure) | 93568 | Addon Code MPFS Status: Active Code APC N ASC N1 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for nonselective pulmonary arterial angiography (List separately in addition to code for primary procedure) | 93569 | Add-on Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, unilateral (List separately in addition to code for primary procedure) | 93573 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, bilateral (List separately in addition to code for primary procedure) | 93574 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary venous angiography of each distinct pulmonary vein during cardiac catheterization (List separately in addition to code for primary procedure) | 93575 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary angiography of major aortopulmonary collateral arteries (MAPCAs) arising off the aorta or its systemic branches, during cardiac catheterization for congenital heart defects, each distinct vessel (List separately in addition to code for primary procedure) | 93662 | Addon Code MPFS Status: Carrier Priced APC N PUB 100 CPT Assistant Article Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure) |
| 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. | 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. | 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 | CR | Catastrophe/disaster related | 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 | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2016-01-01 | Added | Added |
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