How To Use CPT Code 33369

CPT 33369 describes the use of cardiopulmonary bypass support 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 33369?

CPT 33369 is a code that specifically describes the use of cardiopulmonary bypass support during a transcatheter aortic valve replacement (TAVR/TAVI) procedure. This code is used when the provider utilizes central arterial and venous cannulation, such as the aorta, right atrium, and pulmonary artery, to support the patient’s circulation during the TAVR/TAVI procedure.

2. Official Description

The official description of CPT code 33369 is: ‘Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with central arterial and venous cannulation (eg, aorta, right atrium, pulmonary artery) (List separately in addition to code for primary procedure).’ This code should be used in conjunction with the primary procedure code for 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 cardiopulmonary bypass (CPB), to bypass the patient’s heart and lungs.
3. Central arterial and venous cannulation is performed, typically through the aorta, right atrium, and pulmonary artery, to establish the necessary connections for CPB.
4. The provider connects the cannulas to the heart-lung machine, allowing for oxygenation of the patient’s blood and maintaining circulation.
5. The TAVR/TAVI procedure is then performed, which involves replacing the aortic valve with a prosthetic valve.
6. At the completion of the TAVR/TAVI procedure, the provider discontinues cardiopulmonary bypass, ensuring the patient’s heart and lung function return to normal.
7. The provider repairs any open vessel incisions made during the procedure.

4. Qualifying circumstances

CPT 33369 is used when the provider utilizes cardiopulmonary bypass support with central arterial and venous cannulation during a transcatheter aortic valve replacement (TAVR/TAVI) procedure. This code is specific to cases where the aorta, right atrium, and pulmonary artery are cannulated to establish the necessary connections for cardiopulmonary bypass.

5. When to use CPT code 33369

CPT code 33369 should be used when the provider performs a transcatheter aortic valve replacement (TAVR/TAVI) procedure and utilizes cardiopulmonary bypass support with central arterial and venous cannulation. This code should be reported in addition to the primary procedure code for the TAVR/TAVI service.

6. Documentation requirements

To support a claim for CPT 33369, the provider must document the following information:

• Documentation of the primary TAVR/TAVI procedure
• Documentation of the use of cardiopulmonary bypass support
• Specific details of the central arterial and venous cannulation performed
• Start and end times of the cardiopulmonary bypass support
• Repair of any open vessel incisions made during the procedure

7. Billing guidelines

When billing for CPT 33369, ensure that the primary TAVR/TAVI procedure is also reported. This code should be listed separately in addition to the primary procedure code. It is important to note that CPT 33369 should not be reported in conjunction with codes 33367 and 33368. Additionally, be aware of any specific billing guidelines provided by payers regarding the use of CPT 33369.

8. Historical information

CPT 33369 was added to the Current Procedural Terminology system on January 1, 2013. It has not undergone any updates since its addition. It is worth noting that this code was added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A provider performs a transcatheter aortic valve replacement (TAVR/TAVI) procedure and utilizes cardiopulmonary bypass support with central arterial and venous cannulation.
2. During a TAVR/TAVI procedure, the provider establishes central arterial and venous cannulation through the aorta, right atrium, and pulmonary artery to support cardiopulmonary bypass.
3. A patient undergoes a TAVR/TAVI procedure, and the provider utilizes cardiopulmonary bypass support with central arterial and venous cannulation to maintain circulation during the procedure.
4. During a transcatheter aortic valve replacement (TAVR/TAVI) procedure, the provider employs cardiopulmonary bypass support with central arterial and venous cannulation to ensure a still operative field.
5. A provider performs a TAVR/TAVI procedure and utilizes central arterial and venous cannulation for cardiopulmonary bypass support.
6. During a TAVR/TAVI procedure, the provider establishes central arterial and venous cannulation to support cardiopulmonary bypass and maintain circulation.