How To Use CPT Code 33340

CPT 33340 refers to the percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including various imaging and supervision services. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 33340.

1. What is CPT 33340?

CPT 33340 is a medical procedure code used to describe the percutaneous transcatheter closure of the left atrial appendage with endocardial implant. This procedure is performed to prevent blood clots from forming in the left atrial appendage, which can lead to stroke or other complications. The code includes various imaging and supervision services that are necessary for the successful completion of the procedure.

2. 33340 CPT code description

The official description of CPT code 33340 is: “Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation.”

3. Procedure

  1. The patient is prepped, including antibiotic prophylaxis to prevent postoperative infection, and placed under general anesthesia.
  2. An incision is made over the femoral vein, and a catheter is introduced into the vein to obtain vascular access.
  3. The catheter is threaded up through the vein and into the heart using fluoroscopic guidance.
  4. A standard transseptal needle and sheath are used to pierce the septum (the wall between the chambers of the heart) to introduce the delivery system and access the left atrial appendage (LAA).
  5. Heparin may be administered to help prevent clots during the procedure.
  6. Contrast angiography may be used to visualize the left atrium and measure LAA dimensions, which are used to choose the size of the implant device.
  7. Fluoroscopy is used to position the device properly in the LAA cavity.
  8. The sheath is withdrawn over the device, and the device is deployed in position.
  9. A ‘tug test’ is performed to confirm stability and verify seating of the device.
  10. The device is released from the delivery cable, and possible complications are ruled out.
  11. The catheter is withdrawn, and the incision is closed.

4. Qualifying circumstances

Patients eligible to receive CPT code 33340 services are those with a high risk of stroke due to atrial fibrillation and are not suitable candidates for long-term anticoagulation therapy. The procedure is typically recommended for patients who have experienced recurrent blood clots or bleeding complications while on anticoagulation therapy or have contraindications to anticoagulation therapy.

5. When to use CPT code 33340

It is appropriate to bill the 33340 CPT code when the percutaneous transcatheter closure of the left atrial appendage with endocardial implant is performed to prevent blood clots from forming in the left atrial appendage, reducing the risk of stroke or other complications in patients with atrial fibrillation who are not suitable candidates for long-term anticoagulation therapy.

6. Documentation requirements

To support a claim for CPT 33340, the following information should be documented:

  • Patient’s medical history, including atrial fibrillation diagnosis and contraindications or complications with anticoagulation therapy
  • Preoperative evaluation, including imaging studies and laboratory tests
  • Details of the procedure, including anesthesia, catheter placement, device selection, and deployment
  • Postoperative care and follow-up, including any complications or adverse events
  • Radiological supervision and interpretation, if performed

7. Billing guidelines

When billing for CPT code 33340, it is essential to follow the specific guidelines and rules set by the payer. This code includes imaging and supervision and interpretation when performed, so the coder should typically not separately code for the radiology service. Refer to CPT® and payer-specific guidelines to review requirements. Additionally, heart catheterization is included in this procedure unless performed for distinctly different indications than the left atrial appendage closure. Check with the payer to ascertain their policies.

8. Historical information

CPT 33340 was added to the Current Procedural Terminology system on January 1, 2017. It was also added under the Inpatient Only (IPO) list for Medicare in 2017.

9. Similar codes to CPT 33340

Five similar codes to CPT 33340 and how they differentiate from CPT 33340 are:

  1. CPT 33361: Involves the transcatheter aortic valve replacement with prosthetic valve.
  2. CPT 33362: Involves the transcatheter aortic valve replacement with prosthetic valve and includes the use of a transapical approach.
  3. CPT 33363: Involves the transcatheter aortic valve replacement with prosthetic valve and includes the use of a transaortic approach.
  4. CPT 33365: Involves the transcatheter mitral valve repair with an implant.
  5. CPT 33366: Involves the transcatheter mitral valve repair with an implant and includes the use of a transapical approach.

10. Examples

Here are 10 detailed examples of CPT code 33340 procedures:

  1. A 70-year-old patient with a history of atrial fibrillation and recurrent gastrointestinal bleeding while on anticoagulation therapy undergoes percutaneous transcatheter closure of the left atrial appendage with endocardial implant.
  2. A 65-year-old patient with atrial fibrillation and a history of intracranial hemorrhage while on anticoagulation therapy undergoes percutaneous transcatheter closure of the left atrial appendage with endocardial implant.
  3. An 80-year-old patient with atrial fibrillation and a contraindication to anticoagulation therapy due to a history of recurrent falls undergoes percutaneous transcatheter closure of the left atrial appendage with endocardial implant.
  4. A 75-year-old patient with atrial fibrillation and a history of recurrent blood clots in the legs while on anticoagulation therapy undergoes percutaneous transcatheter closure of the left atrial appendage with endocardial implant.
  5. A 68-year-old patient with atrial fibrillation and a history of recurrent pulmonary embolism while on anticoagulation therapy undergoes percutaneous transcatheter closure of the left atrial appendage with endocardial implant.
  6. A 72-year-old patient with atrial fibrillation and a contraindication to anticoagulation therapy due to a history of severe renal impairment undergoes percutaneous transcatheter closure of the left atrial appendage with endocardial implant.
  7. A 77-year-old patient with atrial fibrillation and a history of recurrent deep vein thrombosis while on anticoagulation therapy undergoes percutaneous transcatheter closure of the left atrial appendage with endocardial implant.
  8. A 63-year-old patient with atrial fibrillation and a contraindication to anticoagulation therapy due to a history of liver cirrhosis undergoes percutaneous transcatheter closure of the left atrial appendage with endocardial implant.
  9. A 71-year-old patient with atrial fibrillation and a history of recurrent ischemic stroke while on anticoagulation therapy undergoes percutaneous transcatheter closure of the left atrial appendage with endocardial implant.
  10. A 76-year-old patient with atrial fibrillation and a contraindication to anticoagulation therapy due to a history of uncontrolled hypertension undergoes percutaneous transcatheter closure of the left atrial appendage with endocardial implant.

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *