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The procedure described by CPT® Code 33991 involves the insertion of a ventricular assist device (VAD) through a percutaneous approach, which means that the device is inserted through the skin rather than through an open surgical procedure. A VAD is a mechanical pump designed to provide circulatory support for patients suffering from heart failure. It is particularly beneficial for patients who have end-stage heart disease and are not suitable candidates for heart transplantation, as well as for those who may have reversible cardiac conditions. The primary function of a VAD is to assist the heart, particularly the left ventricle, in pumping blood effectively throughout the body. In this specific procedure, both arterial and venous access is utilized, which involves inserting cannulas into the femoral artery and femoral vein. The procedure is guided by radiological supervision, ensuring accurate placement of the device. A transseptal puncture is performed to create an opening between the right and left atria, allowing for the proper positioning of the cannula in the left atrium. This setup enables the VAD to withdraw oxygenated blood from the left atrium, which is then propelled through an outflow port and returned to the peripheral arterial system, thereby enhancing blood circulation in patients with compromised heart function.
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The insertion of a ventricular assist device (VAD) using CPT® Code 33991 is indicated for patients experiencing severe heart failure. The specific indications include:
The procedure for the insertion of a ventricular assist device (VAD) as described by CPT® Code 33991 involves several critical steps:
After the insertion of the ventricular assist device, patients typically require close monitoring in a critical care setting. Post-procedure care includes assessing the function of the VAD, monitoring vital signs, and ensuring there are no complications such as bleeding or infection at the cannulation sites. Patients may also need to undergo imaging studies to confirm the proper placement of the device. Recovery protocols will vary based on the patient's overall condition and response to the procedure, and ongoing follow-up will be necessary to manage the patient's heart failure and the functioning of the VAD.
| Short Descr | INSJ PERQ VAD L HRT ARTL&VEN | Medium Descr | INSJ PERQ VAD W/RS&I L HRT ARTERIAL&VEN ACCESS | Long Descr | Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, both arterial and venous access, with transseptal puncture | 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) | 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) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 50 - Extracorporeal circulation auxiliary to open heart procedures |
This is a primary code that can be used with these additional add-on codes.
| 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) | 34715 | Addon Code MPFS Status: Active Code APC N ASC N1 Open axillary/subclavian artery exposure for delivery of endovascular prosthesis by infraclavicular or supraclavicular 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) | 34812 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral (List separately in addition to code for primary procedure) | 34820 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular therapy, by abdominal or retroperitoneal 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) | 34834 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open brachial artery exposure for delivery of endovascular prosthesis, unilateral (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. | 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). | 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. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure 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 | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GZ | Item or service expected to be denied as not reasonable and necessary | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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| 2022-01-01 | Changed | AMA guideline removed. |
| 2021-01-01 | Changed | Code changed. |
| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. Guideline added. |
| 2013-01-01 | Added | Added |
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