2025 CPT code 33391
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; complex (e.g., leaflet extension, leaflet resection, leaflet reconstruction, or annuloplasty)
Modifiers may be applicable depending on the specific circumstances of the procedure (e.g., modifier 59 for distinct procedural service, modifier 62 for two surgeons).
Medical necessity is established by the presence of symptomatic aortic valve disease (stenosis or regurgitation) that significantly impacts the patient's quality of life and requires surgical intervention to improve cardiac function. Documentation must support the severity of the disease and the need for complex repair rather than simpler procedures.
The cardiac surgeon is responsible for all aspects of the open-heart surgery, including pre-operative planning, the surgical procedure itself, and post-operative care coordination.
In simple words: This code describes a major heart surgery where the surgeon opens the chest to repair a damaged aortic valve. A machine keeps the blood flowing while the heart is temporarily stopped. The repair might involve fixing or replacing parts of the valve.
This CPT code 33391 represents a complex valvuloplasty of the aortic valve performed through an open incision with the assistance of cardiopulmonary bypass (CPB).The complexity involves procedures such as leaflet extension, resection, reconstruction, or annuloplasty.The procedure necessitates the use of CPB to maintain circulatory function while the heart is temporarily stopped. The surgeon makes an incision, accesses the heart, and performs the necessary valve repair techniques. The procedure concludes with the cessation of CPB, hemostasis (stopping bleeding), and closure of the incision.
Example 1: A 70-year-old patient presents with severe aortic stenosis and symptoms of angina and shortness of breath.A transthoracic echocardiogram confirms significant aortic stenosis.The patient undergoes an open-heart procedure (33391) with cardiopulmonary bypass to perform a complex aortic valve repair, including leaflet reconstruction., A 65-year-old patient with bicuspid aortic valve and moderate aortic stenosis undergoes a complex aortic valve repair requiring leaflet extension and annuloplasty.The procedure is performed via sternotomy with cardiopulmonary bypass (33391)., An 80-year-old patient with a history of rheumatic heart disease presents with severe aortic regurgitation and stenosis.The patient undergoes an open-heart procedure with cardiopulmonary bypass (33391) for complex aortic valve repair, which included leaflet resection and reconstruction.
* Complete patient history and physical examination* Preoperative echocardiogram and other relevant imaging studies* Operative report detailing the specific techniques used during the valve repair (leaflet extension, resection, reconstruction, or annuloplasty)* Intraoperative and postoperative hemodynamic data* Pathology report (if applicable)* Postoperative echocardiogram* Documentation of all complications and their management
** This code is for complex aortic valve repair.Simpler procedures should be coded using 33390.Always refer to the most current CPT codebook and payer guidelines for accurate coding.
- Revenue Code: P2F (MAJOR PROCEDURE, CARDIOVASCULAR - OTHER)
- RVU: Information not available in provided text.RVUs vary by location and payer.
- Global Days: Information not available in provided text. Global surgical days vary based on payer and local practice.
- Payment Status: Active
- Modifier TC rule: Not applicable to this procedure.
- Fee Schedule: Information not available in provided text. Fee schedules are location and payer specific.
- Specialties:Cardiothoracic Surgery
- Place of Service:Inpatient Hospital