How To Use CPT Code 33365

CPT 33365 describes the procedure of transcatheter aortic valve replacement (TAVR/TAVI) using a transaortic approach. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 33365?

CPT 33365 involves the insertion of an aortic valve replacement through a catheter using a transaortic approach. This procedure, also known as TAVR or TAVI, is performed to replace a damaged aortic valve with a prosthetic valve. The provider accesses the aorta through an open incision in the chest, such as a median sternotomy or mediastinotomy, and uses imaging guidance to navigate the vascular system and place the valve.

2. Official Description

The official description of CPT code 33365 is: ‘Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy).’ This code includes the insertion of the valve using a catheter through the lumen, or interior channel, of the catheter.

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. An open incision is made in the chest, such as a median sternotomy or mediastinotomy, to access the aorta.
3. The provider may institute cardiopulmonary bypass, if necessary.
4. The provider opens the sac surrounding the heart and cross clamps the artery.
5. A catheter is inserted into the aorta to reach the target valve.
6. A balloon catheter is inflated and deflated in the native valve to prepare for the introduction of the prosthetic valve.
7. The provider introduces the prosthetic valve and places it at the site of the patient’s damaged aortic valve.
8. After placing drainage tubes, the necessary steps for closing the surgical procedure are performed.
9. Imaging guidance is used throughout the procedure to assist with navigating the vascular system and placing the valve.

4. Qualifying circumstances

CPT 33365 is performed on patients who require aortic valve replacement using a transaortic approach. The procedure is typically reserved for patients with a damaged aortic valve that cannot be repaired through other means. The provider must make an open incision in the chest, such as a median sternotomy or mediastinotomy, to access the aorta. The use of imaging guidance and the placement of a prosthetic valve are also qualifying circumstances for this code.

5. When to use CPT code 33365

CPT code 33365 should be used when a provider performs a transcatheter aortic valve replacement using a transaortic approach. This code is specific to the insertion of the valve through the lumen of a catheter. It should not be used for other approaches or procedures, such as transapical or transfemoral approaches.

6. Documentation requirements

To support a claim for CPT code 33365, the provider must document the following information:

• Patient’s diagnosis and the need for aortic valve replacement
• Details of the procedure, including the approach used (eg, median sternotomy, mediastinotomy)
• Date of the procedure
• Imaging guidance used during the procedure
• Placement of the prosthetic valve
• Any separately reportable services, such as cardiopulmonary bypass or transesophageal echocardiogram
• Signature of the provider

7. Billing guidelines

When billing for CPT code 33365, ensure that the procedure meets the qualifying circumstances, including the use of a transaortic approach. If cardiopulmonary bypass is performed, use the appropriate add-on code (+33367 or +33369) to report this separately. Providers may also report a separately reportable transesophageal echocardiogram, if performed. It is important to follow the specific guidelines and requirements of the payer when submitting claims for CPT code 33365.

8. Historical information

CPT code 33365 was added to the Current Procedural Terminology system on January 1, 2013. In 2017, it was added to the Inpatient Only (IPO) list for Medicare reimbursement.

9. Examples

1. A patient with severe aortic valve stenosis undergoes transcatheter aortic valve replacement using a transaortic approach.
2. A provider performs a TAVR procedure on a patient with a damaged aortic valve, using a transaortic approach through a median sternotomy.
3. A patient with aortic valve regurgitation receives a transcatheter aortic valve replacement via a transaortic approach.
4. A provider performs a TAVR procedure on a patient with aortic valve disease, using a transaortic approach through a mediastinotomy.
5. A patient with aortic valve calcification undergoes transcatheter aortic valve replacement using a transaortic approach.
6. A provider performs a TAVR procedure on a patient with aortic valve insufficiency, using a transaortic approach through a median sternotomy.
7. A patient with aortic valve stenosis and comorbidities undergoes transcatheter aortic valve replacement via a transaortic approach.