How To Use CPT Code 33927

CPT 33927 describes the implantation of a total replacement heart system, also known as an artificial heart, with recipient cardiectomy. 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 33927?

CPT 33927 can be used to describe the implantation of a total replacement heart system, or artificial heart, with recipient cardiectomy. This code is used when a provider removes the patient’s heart and replaces it with an artificial heart as a temporary measure until a donor heart is found or for patients who are not eligible for a heart transplant and require permanent mechanical cardiac support.

2. Official Description

The official description of CPT code 33927 is: ‘Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. An incision is made in the center of the chest, from just below the Adam’s apple to just above the navel.
3. The breastbone, or sternum, is divided in half and the rib cage is spread to access the heart.
4. A subcutaneous pocket is created in the muscle in the patient’s abdomen, and the control unit with the internal battery is placed there.
5. The provider administers medication to stop the patient’s heart and places the patient on a heart and lung bypass machine, transferring the patient to total cardiopulmonary bypass (CPB).
6. The provider cross-clamps the aorta and sections the aorta and pulmonary artery close to the valves.
7. The provider removes the heart’s ventricles and connects the artificial heart to the upper chambers of the heart, ensuring there are no leaks.
8. After making all the attachments, the provider removes any air from the system, removes the aortic clamp, and weans the patient off CPB onto the artificial heart.
9. The sternum is repaired and the skin incision over the sternum is closed with sutures or surgical staples.
10. Tubes are inserted in the chest to drain blood and fluid away from the heart, and a tube is inserted through the patient’s mouth or nose into the stomach to drain stomach fluids.
11. A sterile bandage or dressing is applied.

4. Qualifying circumstances

Patients eligible for CPT 33927 are those with end-stage heart failure who have no treatment option other than a heart transplant. The patient must require a total replacement heart system, or artificial heart, either as a temporary measure until a donor heart is found or as permanent mechanical cardiac support. The procedure involves recipient cardiectomy, which means the removal of the patient’s heart.

5. When to use CPT code 33927

CPT code 33927 should be used when a provider performs the implantation of a total replacement heart system, or artificial heart, with recipient cardiectomy. This code is appropriate for patients with end-stage heart failure who require mechanical cardiac support. It should not be used for other types of heart procedures or surgeries.

6. Documentation requirements

To support a claim for CPT 33927, the provider must document the following information:

• Patient’s diagnosis of end-stage heart failure
• Reason for the implantation of a total replacement heart system
• Date of the procedure
• Details of the procedure, including recipient cardiectomy and the implantation of the artificial heart
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 33927, ensure that the procedure meets the criteria for recipient cardiectomy and the implantation of a total replacement heart system. It is important to accurately document the details of the procedure and any additional procedures or complications. CPT code 33927 should not be reported with other codes for ventricular assist device implantation or removal. It is also important to follow any specific billing guidelines provided by insurance payers or Medicare.

8. Historical information

CPT 33927 was added to the Current Procedural Terminology system on January 1, 2018. It was also added to the Inpatient Only (IPO) list for Medicare in 2018.

9. Examples

1. A patient with end-stage heart failure undergoes recipient cardiectomy and the implantation of a total replacement heart system as a temporary measure until a donor heart is found.
2. A patient who is not eligible for a heart transplant requires permanent mechanical cardiac support and undergoes recipient cardiectomy and the implantation of a total replacement heart system.
3. A provider performs recipient cardiectomy and the implantation of a total replacement heart system on a patient with end-stage heart failure due to a congenital heart defect.
4. A patient with end-stage heart failure undergoes recipient cardiectomy and the implantation of a total replacement heart system after multiple failed heart transplant attempts.
5. A provider performs recipient cardiectomy and the implantation of a total replacement heart system on a patient with end-stage heart failure due to coronary artery disease.
6. A patient with end-stage heart failure undergoes recipient cardiectomy and the implantation of a total replacement heart system as a bridge to a future heart transplant.
7. A provider performs recipient cardiectomy and the implantation of a total replacement heart system on a patient with end-stage heart failure due to viral myocarditis.
8. A patient who is not eligible for a heart transplant requires permanent mechanical cardiac support and undergoes recipient cardiectomy and the implantation of a total replacement heart system due to severe cardiomyopathy.
9. A provider performs recipient cardiectomy and the implantation of a total replacement heart system on a patient with end-stage heart failure due to valvular heart disease.
10. A patient with end-stage heart failure undergoes recipient cardiectomy and the implantation of a total replacement heart system as a bridge to recovery.