How To Use CPT Code 33368

CPT 33368 describes the use of cardiopulmonary bypass support with open peripheral arterial and venous cannulation during a transcatheter aortic valve replacement (TAVR/TAVI) procedure. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 33368?

CPT 33368 is a specific code used to describe the use of cardiopulmonary bypass support with open peripheral arterial and venous cannulation during a transcatheter aortic valve replacement (TAVR/TAVI) procedure. This code is used when the provider utilizes a heart-lung machine to bypass the heart and lungs, allowing for an operative field and oxygenation of the blood. The provider achieves open access to peripheral arteries and veins, such as the femoral artery, to perform the necessary interventions.

2. Official Description

The official description of CPT code 33368 is: ‘Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (eg, femoral, iliac, axillary vessels) (List separately in addition to code for primary procedure).’ This code should be used in conjunction with other primary procedure codes related to the TAVR/TAVI service.

3. Procedure

1. During a TAVR/TAVI procedure, the provider prepares the patient and administers anesthesia.
2. The provider then utilizes a heart-lung machine, also known as a cardiopulmonary bypass (CPB) system, to bypass the heart and lungs.
3. Open peripheral arterial and venous cannulation is performed, typically through vessels such as the femoral artery or other peripheral arteries and veins outside the chest and abdomen.
4. The provider connects the cannulas to the heart-lung machine, allowing for oxygenation of the blood and a still operative field.
5. The necessary interventions for the TAVR/TAVI procedure are then performed.
6. At the completion of the TAVR/TAVI procedure, the provider ensures a return to normal heart and lung function and repairs the open vessel incisions.

4. Qualifying circumstances

CPT 33368 is used when the provider utilizes cardiopulmonary bypass support with open peripheral arterial and venous cannulation during a TAVR/TAVI procedure. This may be necessary in cases where the patient requires bypass of the heart and lungs for oxygenation and an operative field. The procedure involves open access to peripheral arteries and veins, such as the femoral artery, for cannulation.

5. When to use CPT code 33368

CPT code 33368 should be used when the provider performs a TAVR/TAVI procedure and utilizes cardiopulmonary bypass support with open peripheral arterial and venous cannulation. This code should be used in addition to the primary procedure code(s) that describe the specific TAVR/TAVI service being performed.

6. Documentation requirements

To support a claim for CPT 33368, the provider must document the following information:

• Documentation of the TAVR/TAVI procedure being performed
• Documentation of the use of cardiopulmonary bypass support with open peripheral arterial and venous cannulation
• Specific details of the vessels cannulated, such as the femoral artery or other peripheral arteries and veins
• Documentation of the use of a heart-lung machine and its connection to the cannulas
• Documentation of the repair of open vessel incisions and the return to normal heart and lung function

7. Billing guidelines

When billing for CPT 33368, ensure that the procedure meets the qualifying circumstances for the use of cardiopulmonary bypass support with open peripheral arterial and venous cannulation during a TAVR/TAVI procedure. This code should be reported in addition to the primary procedure code(s) that describe the specific TAVR/TAVI service being performed. It is important to note that CPT 33368 should not be reported in conjunction with CPT codes 33367 and 33369.

8. Historical information

CPT 33368 was added to the Current Procedural Terminology system on January 1, 2013. It has not undergone any updates since its addition. Additionally, it is important to note that CPT 33368 is listed as an inpatient-only (IPO) procedure for Medicare reimbursement purposes.

9. Examples

1. A provider performs a TAVR procedure utilizing cardiopulmonary bypass support with open peripheral arterial and venous cannulation, specifically through the femoral artery.
2. During a TAVI procedure, the provider utilizes a heart-lung machine and open peripheral arterial and venous cannulation through the iliac vessels.
3. A patient undergoes a TAVR/TAVI procedure with cardiopulmonary bypass support and open peripheral arterial and venous cannulation via the axillary vessels.
4. During a TAVR/TAVI procedure, the provider utilizes a heart-lung machine and open peripheral arterial and venous cannulation through both the femoral artery and vein.
5. A provider performs a TAVR/TAVI procedure with cardiopulmonary bypass support and open peripheral arterial and venous cannulation through vessels other than the femoral, iliac, or axillary.