How To Use CPT Code 33928

CPT 33928 describes the removal and replacement of a total replacement heart system, also known as an artificial heart. 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 33928?

CPT 33928 is used to describe the removal and replacement of a total replacement heart system, specifically an artificial heart. This code is used when a provider removes a previously placed artificial heart and implants a new one. The procedure is typically performed 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 33928 is: ‘Removal and replacement of total replacement heart system (artificial heart).’ This code should be used when the provider removes and replaces the implanted artificial heart, including the artificial ventricles, connecting to the natural atria and corresponding valves, and the motorized pumping system or pneumatic air pressure system, depending on the type of artificial heart.

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The provider excises the scar from the original total artificial heart (TAH) implantation surgery.
3. The provider locates and evaluates the artificial heart, disconnects it from the atria, and removes it.
4. A new artificial heart is implanted, connecting it to the atria as before.
5. The provider repairs the sternum, sewing it together with small wires, and closes the skin incision over the sternum with sutures or surgical staples.
6. Tubes are inserted in the chest and connected to a suction device to drain blood and fluid away from the heart.
7. A tube is inserted through the patient’s mouth or nose into the stomach to drain stomach fluids.
8. A sterile bandage or dressing is applied to the incision site.

4. Qualifying circumstances

CPT 33928 is performed on patients with end-stage heart failure who have no treatment option other than a heart transplant. The procedure is typically done 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. The patient must have a previously placed artificial heart that needs to be removed and replaced.

5. When to use CPT code 33928

CPT code 33928 should be used when a provider performs the removal and replacement of a total replacement heart system, specifically an artificial heart. This code is appropriate when the provider removes a previously placed artificial heart and implants a new one. It should not be used for the removal of the patient’s native heart and placement of a total artificial heart (use CPT 33927 for that) or for the removal of a previously placed artificial heart to implant a donor heart (use CPT 33929 for that).

6. Documentation requirements

To support a claim for CPT 33928, the provider must document the following information:

• Reason for the removal and replacement of the artificial heart
• Details of the procedure, including the specific steps taken
• Date of the procedure
• Start and end time of the procedure
• Any complications or unexpected findings during the procedure
• Details of the repair of the sternum and closure of the incision
• Use of any tubes or drains
• Post-procedure instructions or recommendations

7. Billing guidelines

When billing for CPT 33928, ensure that the procedure involves the removal and replacement of a total replacement heart system, specifically an artificial heart. It should not be reported with other codes for revision or replacement of components only. Additional tips for reporting CPT 33928 may include considering the location of the testing and the use of modifiers for pulmonary function tests.

8. Historical information

CPT 33928 was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates to the code since its addition. 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 the removal and replacement of an artificial heart 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 the removal and replacement of an artificial heart.
3. A provider removes a previously placed artificial heart that has failed and implants a newer model for a patient.
4. A patient with a total replacement heart system requires a replacement due to other medical reasons, and the provider performs the removal and replacement procedure.
5. A patient with a total replacement heart system experiences complications, and the provider performs the removal and replacement procedure to address the issues.
6. A provider removes a previously placed artificial heart and implants a new one for a patient who needs permanent mechanical cardiac support.
7. A patient with end-stage heart failure undergoes the removal and replacement of an artificial heart as a temporary measure until a suitable donor heart is found.
8. A provider performs the removal and replacement of an artificial heart for a patient who requires permanent mechanical cardiac support and is not eligible for a heart transplant.
9. A patient’s previously placed artificial heart fails, and the provider performs the removal and replacement procedure to ensure continued cardiac support.