2025 CPT code 33369
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Cardiopulmonary bypass support with central arterial and venous cannulation during transcatheter aortic valve replacement (TAVR/TAVI).
Modifiers may be applied based on the circumstances of the procedure.For example, modifier 59 might be used to indicate a separate and distinct procedure if other services are performed.Consult the current CPT coding guidelines for specific modifier applications.
Medical necessity for CPB during TAVR/TAVI is typically documented based on the patient's risk profile (e.g., frailty, complex anatomy, significant comorbidities), hemodynamic instability during the procedure, or anticipated challenges with the procedure that would be mitigated by CPB.Justification should be clearly stated in the patient’s chart.
The cardiothoracic surgeon or cardiac interventionalist is primarily responsible for this procedure.Anesthesiologists and perfusionists play supporting roles.
In simple words: This code describes the use of a heart-lung machine during a TAVR/TAVI procedure. The machine temporarily takes over the function of the heart and lungs, allowing the doctor to perform the valve replacement more easily.The machine is connected to major blood vessels, and after the procedure is complete, the patient is taken off the machine, and the blood vessels are repaired.
This add-on code reports cardiopulmonary bypass (CPB) support with central arterial and venous cannulation (e.g., aorta, right atrium, pulmonary artery) during a primary transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI) procedure (codes 33361-33366, 33418, 33477, or their equivalents in other coding systems).The procedure involves prepping and anesthetizing the patient, employing a heart-lung machine to bypass the heart-lung circulation for oxygenation and providing a still operative field. Central arterial and venous cannulation is used to achieve partial or complete CPB, connecting the pump-oxygenator to a central artery or vein to oxygenate the blood.The procedure concludes with the patient being taken off CPB, ensuring the return to normal heart and lung function, and repairing open vessel incisions.
Example 1: A 78-year-old female patient with severe aortic stenosis undergoes TAVR. Due to the patient's complex anatomy and high surgical risk, the cardiothoracic surgeon elects to use CPB with central arterial and venous cannulation to provide a stable operative field and maintain hemodynamic stability. Code 33369 is reported in addition to the primary TAVR code., An 85-year-old male patient with severe aortic stenosis and significant comorbidities undergoes TAVR. The patient has a history of prior cardiac surgery, making the procedure more complex. CPB with central arterial and venous cannulation is used to manage the patient's hemodynamic instability during and after valve deployment. Code 33369 is reported along with the appropriate TAVR code., A 72-year-old patient with moderate aortic stenosis and multiple comorbidities undergoing TAVR experiences a sudden drop in blood pressure during valve deployment. To quickly stabilize the patient and ensure successful valve placement, the physician decides to use CPB with central arterial and venous cannulation. This ensures adequate blood flow to vital organs while the TAVR procedure is completed. Code 33369 is appended to the primary TAVR code.
Detailed operative notes describing the indications for CPB, the cannulation sites (e.g., aorta, right atrium, pulmonary artery), the duration of CPB, and the specifics of the procedure. Anesthesia records should document the patient's hemodynamic stability and any complications. Perfusion records detailing pump flow rates, oxygen saturation levels, and other relevant parameters.
** This code is specifically for CPB with central arterial and venous cannulation. Other approaches to CPB are reported with different codes.Always ensure accurate documentation to support the medical necessity for CPB during the TAVR/TAVI procedure.
- Revenue Code: P2F (Major Procedure, Cardiovascular - Other)
- RVU: This information is not included in the provided text and would need to be obtained from a separate fee schedule or relative value unit database.
- Global Days: This is an add-on code, thus doesn't have a global period.
- Payment Status: Active
- Modifier TC rule: This code does not have a technical component (TC) modifier rule. It is an add-on code that reports the professional component only.
- Fee Schedule: Fee schedule data for this code will vary by payer and location.Consult your payer's fee schedule for the most accurate information.
- Specialties:Cardiothoracic Surgery, Cardiac Interventional Cardiology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center