2025 CPT code 33368
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Aortic Valve Surgical Procedures on the Cardiovascular System Feed
Open peripheral arterial and venous cannulation for cardiopulmonary bypass during transcatheter aortic valve replacement (TAVR/TAVI).
Modifier 62 is required because two surgeons are involved in the TAVR/TAVI procedure.Additional modifiers may be applicable depending on the circumstances of the case (e.g., 51, 58, 78, etc.).
CPB during TAVR/TAVI is medically necessary in patients with high surgical risk factors, hemodynamic instability, or those requiring a more controlled and stable environment during the procedure.Documentation must clearly support the medical necessity in individual cases.
The cardiothoracic surgeon or interventional cardiologist is primarily responsible for performing this procedure.This involves cannulating the peripheral arteries and veins for CPB, managing the CPB machine during the TAVR/TAVI procedure, and ensuring proper decannulation and repair of the vessel incisions. Anesthesiologists are also involved in monitoring the patient and managing anesthesia during the procedure.
- Surgical Procedures on the Cardiovascular System
- Surgical Procedures on the Cardiovascular System > Surgical Procedures on Cardiac Valves > Surgical Procedures on the Aortic Valve
In simple words: This code describes the use of a heart-lung machine during a TAVR/TAVR procedure. The surgeon connects tubes to arteries and veins in the leg or arm to bypass the heart and lungs temporarily during the valve replacement.This allows for a steadier, safer operating environment.
This CPT code, 33368, reports open peripheral arterial and venous cannulation for cardiopulmonary bypass (CPB) support during a transcatheter aortic valve replacement (TAVR/TAVR) procedure.It includes the establishment of open access to a peripheral artery and vein (e.g., femoral artery or other suitable vessels), cannulation of these vessels, connection to the CPB pump–oxygenator, management of CPB during the TAVR/TAVI procedure, decannulation, and repair of the arteriotomy sites.This code is an add-on code and requires a primary TAVR/TAVI procedure code (33361-33366, 33418, 33477, or relevant implantable device codes) to be reported concurrently.Angiography, radiological supervision, and interpretation associated with CPB are included.
Example 1: A 78-year-old female patient with severe aortic stenosis undergoes a TAVR procedure.Due to the complexity of the case and hemodynamic instability, the surgeon uses open peripheral arterial and venous cannulation for CPB support during the valve implantation., An 85-year-old male patient with multiple comorbidities undergoes a TAVR procedure. The surgeon decides to use CPB via open peripheral cannulation due to increased risk of complications during the procedure. This approach provides better hemodynamic stability and control during the TAVR., A 72-year-old patient with bicuspid aortic valve and severe stenosis undergoes a TAVR procedure. Given the high risk of complications and the patient's frailty, the team decides to use CPB with open peripheral cannulation for better hemodynamic support and improved safety profile during the procedure.
* Pre-operative assessment including patient history, physical examination, and imaging studies (echocardiogram, CT scan).* Operative report detailing the type of CPB used (open peripheral arterial and venous cannulation), cannulation sites, duration of CPB, and details of the TAVR/TAVI procedure.* Post-operative assessment including hemodynamic monitoring, echocardiography, and any complications encountered.* Documentation supporting the medical necessity for CPB during the TAVR/TAVI procedure.
** Always refer to the most current CPT codebook and coding guidelines for the most accurate and up-to-date information.Payer-specific guidelines may also apply.
- Revenue Code: P2F (Major Procedure, Cardiovascular - Other)
- RVU: Information not available in provided text. Consult the current CPT codebook or a reliable medical billing resource for RVU values.
- Global Days: Not applicable to this add-on code. Global surgical days are defined by the primary procedure code.
- Payment Status: Active
- Modifier TC rule: Not applicable to this add-on code.
- Fee Schedule: Information not available. Consult a reliable medical billing resource for historical fee schedule data.
- Specialties:Cardiothoracic Surgery, Interventional Cardiology, Cardiac Anesthesiology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center