How To Use CPT Code 33391

CPT 33391 describes the procedure of valvuloplasty for the aortic valve, which involves the reconstruction of a severely malfunctioning valve using an open incision and cardiopulmonary bypass. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 33391?

CPT 33391 can be used to describe the surgical procedure of valvuloplasty for the aortic valve. This procedure involves the reconstruction of a severely malfunctioning valve using an open incision and cardiopulmonary bypass. It is performed to treat aortic stenosis, a condition where the aortic valve becomes narrowed, restricting blood flow from the heart to the rest of the body.

2. Official Description

The official description of CPT code 33391 is: ‘Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; complex (eg, leaflet extension, leaflet resection, leaflet reconstruction, or annuloplasty).’ It is important to note that CPT code 33391 should not be reported in conjunction with CPT code 33390.

3. Procedure

1. The provider begins by creating an open incision in the chest, either through a sternotomy or by separating the ribs, to access the heart and great vessels.
2. The pericardium, the tissue surrounding the heart, is incised to expose the aortic valve.
3. A clamp is placed on the aorta, and the heart is put into cardiac arrest, meaning it is stopped from beating.
4. The patient is connected to a cardiopulmonary bypass (CPB) machine, which takes over the function of the heart and lungs, maintaining oxygenated blood circulation throughout the body.
5. The provider inspects the aortic valve and proceeds with the necessary steps to reconstruct the valve leaflets. This may involve extending the length of the leaflets, resecting portions of the leaflets, or performing annuloplasty to shorten the circumference of the valve’s fibrous ring.
6. The incision in the aorta is closed, and the clamps are removed.
7. Any bleeding is stopped, and the patient is gradually weaned off the cardiopulmonary bypass.
8. The provider closes the chest wall by suturing the layers of tissue together and may place chest or drainage tubes before dressing the incision.

4. Qualifying circumstances

CPT 33391 is performed on patients with severe aortic valve malfunction, specifically aortic stenosis. The procedure requires the use of cardiopulmonary bypass and involves complex techniques such as leaflet extension, leaflet resection, leaflet reconstruction, or annuloplasty.

5. When to use CPT code 33391

CPT code 33391 should be used when a provider performs a complex valvuloplasty procedure on the aortic valve using an open incision and cardiopulmonary bypass. It should not be reported in conjunction with CPT code 33390, which represents a simpler valvuloplasty procedure.

6. Documentation requirements

To support a claim for CPT 33391, the provider must document the following information:

• Patient’s diagnosis of severe aortic valve malfunction
• Description of the complex valvuloplasty techniques performed, such as leaflet extension, leaflet resection, leaflet reconstruction, or annuloplasty
• Date of the procedure
• Details of the surgical approach, including the use of an open incision and cardiopulmonary bypass
• Any additional procedures performed during the same surgical session
• Any complications or unexpected findings
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 33391, ensure that the procedure meets the criteria for a complex valvuloplasty of the aortic valve using an open incision and cardiopulmonary bypass. It should not be reported in conjunction with CPT code 33390. It is important to follow any specific billing guidelines provided by the payer or Medicare. Additionally, consider using appropriate modifiers if required.

8. Historical information

CPT 33391 was added to the Current Procedural Terminology system on January 1, 2017. It is important to note that it is listed under the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A patient with severe aortic stenosis undergoes a complex valvuloplasty procedure on the aortic valve using an open incision and cardiopulmonary bypass.
2. A provider performs leaflet reconstruction during a valvuloplasty procedure for a patient with a severely malfunctioning aortic valve.
3. An individual with aortic valve dysfunction undergoes a valvuloplasty procedure involving annuloplasty to correct the valve’s circumference.
4. A complex valvuloplasty procedure is performed on a patient with aortic valve stenosis, involving both leaflet extension and leaflet resection.
5. A provider performs a valvuloplasty procedure on a patient with severe aortic valve malfunction, using an open incision and cardiopulmonary bypass, to improve blood flow from the heart.