CPT® Code 33929 | Case2Code

Official Description

Removal of a total replacement heart system (artificial heart) for heart transplantation (List separately in addition to code for primary procedure)

Common Language Description

The procedure described by CPT® Code 33929 involves the removal of a total replacement heart system, commonly referred to as a total artificial heart (TAH), which is utilized in patients awaiting heart transplantation. A TAH is a sophisticated mechanical device designed to replace both ventricles of the heart, utilizing polyurethane structures and disc valves that are connected to an external pumping drive. This device serves as a temporary solution, or bridge, for patients with severe heart failure until a suitable donor heart becomes available for transplantation. The surgical process for removing the TAH requires a median sternotomy, which is an incision made through the breastbone to access the heart. During the removal procedure, the aorta and the superior and inferior vena cava are cannulated to establish heart-lung bypass, allowing the surgeon to safely disconnect the external drive lines from the pump device. The internal connectors are then carefully freed from the heart's leaflets, and the leaflets are inspected for any necessary repairs. This procedure is critical in the continuum of care for patients with end-stage heart disease, ensuring that they can transition to a donor heart when it becomes available.

1. Indications

The removal of a total replacement heart system (TAH) is indicated in specific clinical scenarios, primarily when a patient is transitioning from mechanical support to heart transplantation. The following conditions warrant this procedure:

Heart Transplantation: The primary indication for the removal of a TAH is the availability of a donor heart for transplantation in patients who have been supported by the artificial heart.
Device Malfunction: If the TAH experiences mechanical failure or complications that cannot be resolved, removal may be necessary.
Patient Recovery: In cases where the patient's condition has improved sufficiently to allow for the removal of the TAH without immediate replacement, this procedure may be indicated.

2. Procedure

The procedure for removing a total replacement heart system involves several critical steps to ensure patient safety and successful device removal. The following procedural steps are outlined:

Step 1: A median sternotomy is performed to gain access to the thoracic cavity. This involves making an incision through the breastbone to expose the heart and surrounding structures.
Step 2: The aorta is cannulated, followed by the cannulation of the superior and inferior vena cava. This step is essential to establish heart-lung bypass, which allows the surgeon to operate on the heart while maintaining blood circulation and oxygenation.
Step 3: The external drive lines connected to the TAH are disconnected from the pump device. This step is crucial to safely remove the device without causing injury to the surrounding tissues.
Step 4: The internal connectors of the TAH are carefully freed from the heart's leaflets. This requires precision to maintain the patency of the tunnels created for the drive lines.
Step 5: The leaflets of the heart are inspected for any damage or need for repair. If any issues are identified, appropriate repairs are made to ensure the integrity of the heart structure.

3. Post-Procedure

After the removal of the total replacement heart system, the patient will require careful monitoring and post-operative care. The expected recovery process includes observation for any complications related to the surgery, such as bleeding or infection. The surgical site will be assessed for healing, and the patient's overall cardiovascular status will be closely monitored. If a new TAH is to be inserted, as indicated by CPT® Code 33928, the surgical team will prepare for the subsequent implantation procedure. Additionally, the patient may need to continue receiving supportive care and management of their heart condition while awaiting the transplant heart.

Short Descr	RMVL RPLCMT HRT SYS F/TRNSPL
Medium Descr	REMOVAL TOTAL RPLCMT HEART SYS FOR HEART TRNSPL
Long Descr	Removal of a total replacement heart system (artificial heart) for heart transplantation (List separately in addition to code for primary procedure)
Status Code	Carriers Price the 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)	2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
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)	none
MUE	1

This is an add-on code that must be used in conjunction with one of these primary codes.

33945

MPFS Status: Restricted APC C PUB 100 CPT Assistant Article Heart transplant, with or without recipient cardiectomy

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).
GC	This service has been performed in part by a resident under the direction of a teaching physician