2025 CPT code 33365
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (e.g., median sternotomy, mediastinotomy).
Modifier 62 is applicable when two surgeons perform the procedure. Other modifiers may be applicable depending on specific circumstances.
Medical necessity for TAVR is established by demonstrating severe symptomatic aortic stenosis in patients who are appropriate candidates for the procedure based on clinical guidelines and individual risk assessment.
The physician is responsible for the complete TAVR/TAVI procedure including patient preparation, anesthesia, surgical access to the aorta, potential cardiopulmonary bypass, insertion and placement of the prosthetic valve, and closure of the surgical site. Imaging guidance is used throughout the procedure. This typically requires two physician operators.
In simple words: This procedure replaces a stiff or narrowed aortic valve with a new one without open-heart surgery. A small incision is made in the chest, and a thin tube (catheter) is used to guide a new valve to the heart and place it inside the old, faulty valve.This helps restore normal blood flow.
This code describes a transcatheter aortic valve replacement (TAVR/TAVI) procedure using a transaortic approach.The procedure involves replacing a diseased aortic valve with a prosthetic valve via a catheter inserted through an open incision in the chest, such as a median sternotomy or mediastinotomy. This approach may involve cardiopulmonary bypass. The surgeon accesses the aorta, inserts a catheter to reach the aortic valve, performs balloon aortic valvuloplasty, and then deploys the new prosthetic valve. The procedure includes imaging guidance for vascular navigation and valve placement.
Example 1: A 78-year-old patient with severe aortic stenosis and multiple comorbidities is deemed high-risk for traditional open-heart surgery.A TAVR procedure using a transaortic approach (33365) is performed due to the patient's specific anatomical considerations., A 65-year-old patient with aortic stenosis and a history of prior cardiac surgery presents for TAVR. Due to the complexities of prior surgery and the patient's anatomy, a transaortic approach (33365) is chosen for valve replacement., A 55-year-old patient with severe aortic stenosis and unfavorable anatomy for transfemoral or transapical access undergoes TAVR via a transaortic approach (33365). The patient's condition necessitates cardiopulmonary bypass during the valve replacement.
Documentation should include details of the patient's aortic stenosis diagnosis, pre-operative evaluation, operative report with details of the transaortic approach, type of prosthetic valve used, use of cardiopulmonary bypass (if applicable), and post-operative care.Any intraoperative complications should also be documented.
** This code represents a complex procedure and requires careful consideration of the patient's clinical condition, anatomical factors, and procedural details for accurate coding. Always refer to the latest CPT coding guidelines and NCCI edits for up-to-date information.
- Revenue Code: P2F
- Payment Status: Active
- Specialties:Cardiology, Cardiothoracic Surgery, Interventional Cardiology
- Place of Service:Inpatient Hospital