How To Use CPT Code 33993

CPT 33993 describes the repositioning of a percutaneous right or left ventricular assist device (VAD) that has been inserted in a patient during a previous 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 33993?

CPT 33993 can be used to describe the repositioning of a percutaneous right or left ventricular assist device (VAD) that has been inserted in a patient during a previous procedure. This code is used when the provider needs to adjust the placement of the VAD cannula to ensure it is in the correct position. The repositioning procedure is performed under radiologic or imaging guidance.

2. Official Description

The official description of CPT code 33993 is: ‘Repositioning of percutaneous right or left heart ventricular assist device with imaging guidance at separate and distinct session from insertion.’

3. Procedure

1. The provider uses imaging guidance, such as transesophageal echocardiography (TEE), to assist with the repositioning of the ventricular assist device (VAD).
2. The provider inserts a specialized probe with an ultrasound transducer at its tip into the patient’s esophagus to capture detailed images of the heart.
3. Using the images, the provider visualizes the VAD and cannulas and adjusts their position as necessary.
4. The provider may need to reduce the flow level of the VAD and then withdraw or advance the device tip to achieve the appropriate placement.
5. Once the VAD is in the correct position, the provider adjusts the flow level to the appropriate rate.

4. Qualifying circumstances

Patients eligible for CPT 33993 are those who have previously had a percutaneous right or left ventricular assist device (VAD) inserted and require repositioning of the device. The repositioning procedure must be performed at a separate and distinct session from the initial insertion. The provider must use imaging guidance, such as transesophageal echocardiography (TEE), to assist with the repositioning.

5. When to use CPT code 33993

CPT code 33993 should be used when a provider needs to reposition a percutaneous right or left ventricular assist device (VAD) that has been previously inserted in a patient. The repositioning procedure must be performed at a separate and distinct session from the initial insertion. Imaging guidance, such as transesophageal echocardiography (TEE), should be used during the procedure.

6. Documentation requirements

To support a claim for CPT 33993, the provider must document the following information:

• Indication for the repositioning procedure
• Imaging guidance used, such as transesophageal echocardiography (TEE)
• Date and time of the repositioning procedure
• Details of the repositioning procedure, including any adjustments made to the VAD and cannulas
• Flow level adjustments made during the procedure
• Signature of the provider performing the repositioning procedure

7. Billing guidelines

When billing for CPT 33993, ensure that the repositioning procedure is performed at a separate and distinct session from the initial insertion of the ventricular assist device (VAD). Imaging guidance, such as transesophageal echocardiography (TEE), should be used during the procedure. There are no specific guidelines regarding reporting CPT 33993 with other codes.

8. Historical information

CPT 33993 was added to the Current Procedural Terminology system on January 1, 2013. There have been no updates to the code since its addition. However, it is important to note that CPT 33993 was added to the Inpatient Only (IPO) list for Medicare in 2017, meaning it can only be performed in an inpatient setting.

9. Examples

1. A patient who previously had a percutaneous left ventricular assist device (VAD) inserted requires repositioning of the device to ensure proper placement of the cannula. The provider performs the repositioning procedure using imaging guidance, adjusting the VAD and cannulas as necessary.
2. Following the insertion of a percutaneous right ventricular assist device (VAD), the provider determines that the device needs to be repositioned. Using imaging guidance, the provider adjusts the VAD and cannulas to achieve the correct placement.
3. A patient with a previously inserted percutaneous left ventricular assist device (VAD) experiences complications due to improper placement of the device. The provider performs a repositioning procedure using imaging guidance to correct the placement and ensure optimal functioning of the VAD.
4. After the insertion of a percutaneous right ventricular assist device (VAD), the provider determines that the device needs to be repositioned for better support of the weakened heart. Using imaging guidance, the provider adjusts the VAD and cannulas to achieve the desired position.
5. A patient who previously had a percutaneous left ventricular assist device (VAD) inserted requires repositioning of the device due to migration. The provider performs the repositioning procedure using imaging guidance, ensuring the VAD and cannulas are properly placed.
6. Following the insertion of a percutaneous right ventricular assist device (VAD), the provider identifies the need for repositioning to optimize cardiac support. Using imaging guidance, the provider adjusts the VAD and cannulas to achieve the desired position and flow rate.