2025 CPT code 33366
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve, transapical exposure (e.g., left thoracotomy).
Modifier 62 (Two Surgeons) is required for TAVR, as it typically involves two surgeons. Modifier 59 may be used if a separate diagnostic coronary angiography is performed and meets specific criteria.
Medical necessity for TAVR is established by documentation of symptomatic severe aortic stenosis in patients who are considered high-risk or inoperable for traditional open-heart surgery, or who have anatomical factors that favor a transapical approach. Shared decision-making with the patient should be documented, discussing risks and benefits of TAVR versus SAVR.
The physician prepares the patient under general anesthesia, makes an incision between the ribs, and uses imaging guidance to insert the prosthetic valve and delivery system. The valve is expanded within the existing valve, and the incision is closed. Post-procedure care includes monitoring heart function.
In simple words: This procedure replaces a diseased aortic valve with a new one without open-heart surgery. A small incision is made in the chest, and a catheter is used to guide the new valve to the heart, where it is placed inside the old, faulty valve. This minimally invasive technique offers a faster recovery compared to traditional surgery.
This code describes a transcatheter aortic valve replacement (TAVR/TAVI) procedure using a prosthetic valve via a transapical approach. This involves accessing the heart through the left ventricular apex, typically via a small incision in the chest. The procedure includes percutaneous access, sheath placement, potential balloon valvuloplasty, positioning and deployment of the valve, temporary pacemaker insertion (if needed), and arteriotomy closure. It also encompasses imaging guidance, radiological supervision, and interpretation.
Example 1: A 78-year-old patient with severe aortic stenosis and multiple comorbidities is considered high-risk for traditional open-heart surgery. TAVR via transapical access is performed to replace the diseased valve., A 65-year-old patient with aortic stenosis and a porcelain aorta (extensive calcification) undergoes TAVR using a transapical approach. The transapical access allows the surgeon to avoid the heavily calcified aorta., A 55-year-old patient with aortic stenosis and prior cardiac surgery is deemed a suitable candidate for TAVR. A transapical approach is used due to prior sternotomy making a transfemoral approach less feasible.
Documentation should include patient history, pre-operative evaluation results (including imaging studies), operative report detailing the procedure, type of valve used, and post-operative course including any complications.
** TAVR is a less invasive alternative to traditional open-heart surgery for aortic valve replacement. It has shown similar or better outcomes in some patient populations. This transapical approach requires specific anatomical considerations.
- Revenue Code: P2F - MAJOR PROCEDURE, CARDIOVASCULAR - OTHER
- Payment Status: Active
- Specialties:Interventional Cardiology, Cardiothoracic Surgery
- Place of Service:Inpatient Hospital