How To Use CPT Code 33361

CPT 33361 refers to the transcatheter aortic valve replacement (TAVR/TAVI) procedure with a prosthetic valve using a percutaneous femoral artery approach. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 33361.

1. What is CPT 33361?

CPT 33361 is a medical procedure code used to describe the transcatheter aortic valve replacement (TAVR/TAVI) with a prosthetic valve using a percutaneous femoral artery approach. This minimally invasive procedure is performed to replace a damaged or malfunctioning aortic valve in the heart without the need for open-heart surgery. The code is specific to the femoral artery approach, which involves accessing the patient’s vascular system through the femoral artery in the groin area.

2. 33361 CPT code description

The official description of CPT code 33361 is: “Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach.”

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. A small incision is made in the groin area to access the femoral artery.
3. A compressed prosthetic aortic valve is inserted into the femoral artery and advanced to the heart using a catheter.
4. The space is prepped, typically with a balloon catheter, to position the valve at the site of the damaged aortic valve.
5. Imaging guidance is used to assist with navigating the vascular system and placing the valve.
6. The prosthetic valve is deployed, replacing the damaged aortic valve.
7. The catheter and other instruments are removed, and the incision is closed.

4. Qualifying circumstances

Patients eligible to receive CPT code 33361 services are those with severe aortic valve stenosis or regurgitation who are considered high risk for traditional open-heart surgery. The decision to perform TAVR/TAVI is typically based on a thorough evaluation of the patient’s medical history, symptoms, and overall health. Factors that may contribute to a patient’s eligibility for this procedure include age, frailty, comorbidities, and the presence of other risk factors such as lung or kidney disease.

5. When to use CPT code 33361

CPT code 33361 should be used when billing for the TAVR/TAVI procedure with a prosthetic valve using a percutaneous femoral artery approach. This code is appropriate when the provider has determined that the patient meets the qualifying circumstances for the procedure and has performed the necessary steps to replace the damaged aortic valve using the femoral artery approach.

6. Documentation requirements

Documentation supporting a claim for CPT 33361 should include a comprehensive patient history, physical examination, and diagnostic tests confirming the presence of severe aortic valve stenosis or regurgitation. The provider should also document the patient’s risk factors and the rationale for choosing the TAVR/TAVI procedure over traditional open-heart surgery. Additionally, the provider should include a detailed description of the procedure, including the steps taken, the type of prosthetic valve used, and any complications or additional interventions that occurred during the procedure.

7. Billing guidelines

When billing for CPT code 33361, it is essential to follow the appropriate billing guidelines and rules. This code includes a variety of services, such as imaging guidance, and requires the involvement of two physicians, represented using modifier 62. Ensure that all necessary documentation is provided to support the claim and that the patient meets the qualifying circumstances for the procedure. It is also crucial to stay up-to-date with any changes to billing guidelines or reimbursement rates for this code.

8. Historical information

CPT 33361 was added to the Current Procedural Terminology system on January 1, 2013. In 2017, it was added to the Medicare Inpatient Only (IPO) list.

9. Similar codes to CPT 33361

There are several similar codes to CPT 33361, which differ based on the approach used for the TAVR/TAVI procedure or the specific services provided. These include:

• CPT 33362: This code is used for TAVR/TAVI procedures with a transapical approach, which involves accessing the heart through the apex of the left ventricle.
• CPT 33363: This code is used for TAVR/TAVI procedures with a transaortic approach, which involves accessing the heart through the aorta.
• CPT 33364: This code is used for TAVR/TAVI procedures with an alternative access site, such as the subclavian or axillary artery.
• CPT 33365: This code is used for TAVR/TAVI procedures with a direct aortic approach, which involves accessing the heart through the ascending aorta.
• CPT 33366: This code is used for TAVR/TAVI procedures with a cardiopulmonary bypass support, which involves using a heart-lung machine to support the patient during the procedure.

10. Examples

Here are ten detailed examples of CPT code 33361 procedures:

1. A 75-year-old patient with severe aortic stenosis and multiple comorbidities undergoes TAVR/TAVI with a prosthetic valve using a percutaneous femoral artery approach.
2. An 80-year-old patient with a history of heart failure and severe aortic regurgitation undergoes TAVR/TAVI with a prosthetic valve using a percutaneous femoral artery approach.
3. A 70-year-old patient with severe aortic stenosis and chronic kidney disease undergoes TAVR/TAVI with a prosthetic valve using a percutaneous femoral artery approach.
4. A 78-year-old patient with severe aortic stenosis and a history of stroke undergoes TAVR/TAVI with a prosthetic valve using a percutaneous femoral artery approach.
5. An 82-year-old patient with severe aortic regurgitation and a history of lung disease undergoes TAVR/TAVI with a prosthetic valve using a percutaneous femoral artery approach.
6. A 76-year-old patient with severe aortic stenosis and a history of coronary artery disease undergoes TAVR/TAVI with a prosthetic valve using a percutaneous femoral artery approach.
7. An 85-year-old patient with severe aortic regurgitation and a history of diabetes undergoes TAVR/TAVI with a prosthetic valve using a percutaneous femoral artery approach.
8. A 73-year-old patient with severe aortic stenosis and a history of peripheral artery disease undergoes TAVR/TAVI with a prosthetic valve using a percutaneous femoral artery approach.
9. An 81-year-old patient with severe aortic regurgitation and a history of atrial fibrillation undergoes TAVR/TAVI with a prosthetic valve using a percutaneous femoral artery approach.
10. A 77-year-old patient with severe aortic stenosis and a history of heart attack undergoes TAVR/TAVI with a prosthetic valve using a percutaneous femoral artery approach.