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The CPT® Code 33997 refers to the removal of a percutaneous right heart ventricular assist device (RVAD) venous cannula, which is performed at a separate and distinct session from the insertion of the device. A right ventricular assist device is a mechanical pump designed to provide circulatory support for patients experiencing acute right heart failure. This condition may arise due to various complications, including myocardial ischemia, pulmonary embolism, or postcardiotomy syndrome. The RVAD functions by pumping blood from the right atrium or ventricle into the pulmonary artery, thereby facilitating blood flow to the lungs and relieving pressure on the right side of the heart. The procedure for placing an RVAD involves the insertion of two cannulas: one positioned in the right atrium and the other in the pulmonary artery. This is typically achieved through a percutaneous approach, utilizing fluoroscopic guidance and heparinization to ensure proper placement and minimize complications. The inflow cannula is usually inserted via the femoral vein, while the outflow cannula is placed through the right internal jugular vein. The correct positioning of these cannulas is confirmed through imaging techniques such as fluoroscopy and transesophageal echocardiogram. When the time comes to remove the RVAD, it is crucial to manage anticoagulation carefully as the patient is weaned off the device's support. The removal process involves taking out the cannulas that were previously inserted, which is done in a controlled manner to ensure patient safety and minimize the risk of complications. This code specifically addresses the removal of the venous cannula, highlighting the importance of performing this procedure in a separate session from the initial insertion to ensure proper documentation and billing practices.
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The procedure associated with CPT® Code 33997 is indicated for patients who have undergone the insertion of a right ventricular assist device (RVAD) and require the removal of the venous cannula. The specific indications for this procedure include:
The procedure for the removal of the percutaneous right heart ventricular assist device venous cannula involves several critical steps, which are detailed as follows:
Post-procedure care following the removal of the venous cannula involves careful monitoring of the patient for any adverse effects or complications. This includes observing the access site for bleeding, infection, or hematoma formation. The patient's vital signs should be closely monitored to ensure stability. Additionally, the healthcare team will assess the patient's overall cardiac function and response to the cessation of mechanical support. Follow-up imaging may be necessary to confirm that there are no remaining issues related to the RVAD or the cannula removal. The healthcare provider will also provide instructions for any further anticoagulation management and schedule follow-up appointments to monitor the patient's recovery.
| Short Descr | RMVL PERQ RIGHT HEART VAD | Medium Descr | REMOVAL PERQ R HEART VAD VENOUS CANNULA SEP INSJ | Long Descr | Removal of percutaneous right heart ventricular assist device, venous cannula, at separate and distinct session from insertion | 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) | none | MUE | 1 |
| 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). | 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | 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.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, 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). | 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 | GZ | Item or service expected to be denied as not reasonable and necessary | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2021-01-01 | Added | Code added. |
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