2025 CPT code 33367
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation during transcatheter aortic valve replacement (TAVR/TAVI).
Modifiers may apply depending on the circumstances of the procedure.For example, modifier 59 may be added if the CPB support is considered a separate and distinct service. Consult CPT guidelines for appropriate modifier usage.
Medical necessity is established by the patient's clinical condition requiring CPB support to mitigate operative risk, ensure hemodynamic stability, or facilitate a successful TAVR/TAVI procedure. Documentation should justify the use of CPB based on the patient's clinical profile, including age, comorbidities, and anatomical considerations.Pre-operative assessment should be detailed.
The clinical responsibility includes pre-operative preparation, cannulation of peripheral arteries and veins, connection to the cardiopulmonary bypass machine, management of the CPB circuit, and post-operative decannulation and patient recovery.The surgeon is primarily responsible for the TAVR/TAVI procedure, while the perfusionist manages the CPB machine.
In simple words: This code describes using a heart-lung machine to help during a TAVR/TAVI procedure.The machine temporarily takes over the work of the heart and lungs, allowing the doctor to perform the procedure more easily.Small tubes are inserted into blood vessels in the leg to connect to the machine.
This add-on code reports cardiopulmonary bypass (CPB) support using percutaneous peripheral arterial and venous cannulation (e.g., femoral vessels) during a primary TAVR/TAVI procedure (codes 33361-33366, 33418, 33477, or HCPCS codes 0483T, 0484T, 0544T, 0545T, 0569T, 0570T, 0643T, 0644T).The procedure involves percutaneous access to a peripheral artery and vein, cannulation, connection to the CPB machine for oxygenation, and subsequent decannulation and restoration of normal heart and lung function.This code should not be used with codes 33368 or 33369. For cerebral embolic protection, use code 33370.
Example 1: A 78-year-old female patient with severe aortic stenosis undergoes a TAVR procedure. Due to the patient's high surgical risk, the cardiothoracic surgeon decides to use CPB with percutaneous peripheral arterial and venous cannulation for better hemodynamic stability. Code 33367 is reported in addition to the primary TAVR code., An 82-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) undergoes a TAVR procedure. The use of CPB with percutaneous access is chosen to minimize respiratory complications and maintain oxygen saturation during the procedure.Code 33367 is added to the primary TAVR code., A 65-year-old patient with complex anatomy and a high risk of bleeding requires a TAVR procedure.The use of CPB with percutaneous cannulation allows the surgical team to manage blood loss and maintain adequate blood pressure throughout the intervention. Code 33367 is appended to the primary TAVR code.
Detailed operative notes documenting the use of CPB with percutaneous peripheral arterial and venous cannulation, including cannulation sites, cannula size, duration of CPB, hemodynamic parameters (blood pressure, heart rate, oxygen saturation), and post-operative recovery.Anesthesia records and perfusionist reports are also required.
** This code specifically addresses percutaneous peripheral arterial and venous cannulation.Other approaches to CPB during TAVR/TAVI would require different codes (33368, 33369). The provided text does not contain comprehensive details about RVUs or global days, and that data needs to be verified through external resources such as CMS.
- Revenue Code: P2F (Major Procedure, Cardiovascular - Other)
- RVU: Information not available in provided text.Consult the CMS National Physician Fee Schedule for current RVU values.
- Global Days: Information not available in provided text.This is an add-on code, so a global period would be defined by the primary TAVR/TAVI code.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is an add-on code, and a technical component modifier (TC) does not apply.
- Fee Schedule: Information not available in provided text. Consult historical CMS fee schedules for relevant data.
- Specialties:Cardiothoracic Surgery, Cardiovascular Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center