How To Use CPT Code 33991

CPT 33991 describes the percutaneous insertion of a ventricular assist device (VAD) into the left heart, using both arterial and venous access, with a transseptal puncture. 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 33991?

CPT 33991 can be used to describe the percutaneous insertion of a ventricular assist device (VAD) into the left heart. This procedure involves accessing both the arterial and venous systems and performing a transseptal puncture to create a hole in the wall between the left and right sides of the heart. The VAD is then attached to support the pumping of blood from the left ventricle into the aorta, reducing the workload on the ventricle.

2. Official Description

The official description of CPT code 33991 is: ‘Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, both arterial and venous access, with transseptal puncture.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. An incision is made to access the vascular system.
3. Under radiological guidance, a catheter is threaded through the blood vessels to the heart.
4. A transseptal puncture is performed, creating a hole in the wall between the left and right sides of the heart.
5. The ventricular assist device (VAD) is attached to support the pumping of blood from the left ventricle into the aorta.
6. The provider completes the procedure, including closing the access site.

4. Qualifying circumstances

CPT 33991 is performed on patients who require the insertion of a ventricular assist device (VAD) to support their weakened heart or in cases of heart failure. The procedure is performed percutaneously, using both arterial and venous access, with a transseptal puncture. It is important to note that the provider must assess the patient’s condition and determine the need for a VAD insertion.

5. When to use CPT code 33991

CPT code 33991 should be used when the provider performs the percutaneous insertion of a ventricular assist device (VAD) into the left heart, using both arterial and venous access, with a transseptal puncture. This code accurately describes the specific procedure performed and should be used for reporting purposes.

6. Documentation requirements

To support a claim for CPT 33991, the provider must document the following information:

• Patient’s diagnosis and the need for a ventricular assist device (VAD) insertion
• Details of the procedure, including the use of both arterial and venous access and the transseptal puncture
• Date of the procedure
• Start and end time of the procedure
• Any complications or additional steps taken during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 33991, ensure that the procedure meets the specific criteria outlined in the code description. The provider should document the use of both arterial and venous access, as well as the transseptal puncture. It is important to follow the appropriate coding guidelines and not report CPT 33991 if other codes for VAD insertion, removal, or replacement are already performed within the same encounter. Additionally, consider any specific billing requirements from payers and provide any necessary supporting documentation.

8. Historical information

CPT 33991 was added to the Current Procedural Terminology system on January 1, 2013. The code has undergone changes, including the addition of the transseptal puncture component. It is important to stay updated with any revisions or modifications to the code.

9. Examples

1. A patient with severe heart failure undergoes percutaneous insertion of a ventricular assist device (VAD) into the left heart, using both arterial and venous access, with a transseptal puncture.
2. A provider performs the percutaneous insertion of a ventricular assist device (VAD) into the left heart of a patient with a weakened heart, using both arterial and venous access, with a transseptal puncture.
3. During a cardiac procedure, a ventricular assist device (VAD) is percutaneously inserted into the left heart of a patient, using both arterial and venous access, with a transseptal puncture.
4. A provider performs the percutaneous insertion of a ventricular assist device (VAD) into the left heart of a patient with heart failure, using both arterial and venous access, with a transseptal puncture.
5. Using radiological guidance, a provider inserts a ventricular assist device (VAD) percutaneously into the left heart of a patient, using both arterial and venous access, with a transseptal puncture.
6. A patient with a weakened heart undergoes the percutaneous insertion of a ventricular assist device (VAD) into the left heart, using both arterial and venous access, with a transseptal puncture.
7. A provider performs the percutaneous insertion of a ventricular assist device (VAD) into the left heart of a patient with severe heart failure, using both arterial and venous access, with a transseptal puncture.