2025 CPT code 33999
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Cardiac Surgery Surgery Feed
Unlisted procedure, cardiac surgery; used when no specific CPT code exists for a performed cardiac surgical procedure.
Modifiers may be applicable based on the circumstances of the procedure.Consult the most current CPT guidelines and payer-specific rules to determine the necessity and appropriateness of any modifiers.
Medical necessity must be clearly established with comprehensive documentation outlining the patient's clinical presentation, the need for the procedure, and its clinical rationale.This documentation should justify the choice of 33999 over any potentially relevant specific codes.
The surgeon performing the cardiac surgical procedure is clinically responsible.Accurate and detailed documentation is crucial to support the medical necessity and justify the use of this unlisted code.Pre-operative, operative, and post-operative notes are necessary for a complete clinical picture.
In simple words: This code is used when a heart surgery performed doesn't have a specific code.It's a placeholder that requires detailed documentation from the surgeon to be billed properly, ensuring the insurance company pays for the surgery.
CPT code 33999, "Unlisted procedure, cardiac surgery," is utilized to report cardiac surgical procedures lacking a specific CPT code.This code serves as a placeholder for any cardiac surgical intervention not otherwise categorized within the existing CPT code set.When using this code, comprehensive documentation, including operative notes, details of the procedure performed, and justification for the use of an unlisted code instead of a more specific code, must be submitted to the payer for accurate reimbursement.The documentation should explain why the procedure does not fit into any existing code and clearly outline the steps and complexity involved.This allows for appropriate evaluation and reimbursement by the payer.Failure to provide comprehensive documentation can result in claim denial.
Example 1: A surgeon performs a novel technique for mitral valve repair using a biocompatible polymer not previously described in standard CPT codes. Code 33999 is used, supported by extensive operative notes, diagrams, and justification., A patient requires a complex cardiac surgery involving repair of both the mitral and aortic valves alongside a coronary artery bypass graft.Given the complexity and the lack of a single CPT code encompassing all three procedures, the surgeon uses 33999 with complete documentation of each component., During a routine coronary artery bypass surgery, an unexpected aortic dissection is discovered. The surgeon successfully repairs the dissection, but there is no specific CPT code to reflect the combined procedure, leading to the use of 33999 with detailed documentation.
Detailed operative notes, including a precise description of the procedure, rationale for using code 33999, illustrations or diagrams when applicable, pre-operative and post-operative diagnoses, and any related tests or imaging.
** The use of code 33999 necessitates detailed communication with the payer to ensure proper reimbursement.Submit a comprehensive report with the claim explaining the rationale for using the unlisted procedure code and justifying the charges.Failure to provide adequate supporting documentation will likely lead to claim denial.
- Revenue Code: P2F (MAJOR PROCEDURE, CARDIOVASCULAR - OTHER)
- RVU: The RVUs for 33999 are carrier priced and vary depending on the specific procedure and the payer. Detailed documentation is crucial for accurate reimbursement.
- Global Days : The global period will vary based on the specific cardiac surgical procedure performed and should be determined based on the payer's guidelines and the specific procedure.Comprehensive documentation is crucial for determining the appropriate global period.
- Payment Status: Active, but carrier-priced; payment dependent on comprehensive documentation.
- Modifier TC rule: The use of a technical component (TC) modifier would depend entirely on the specific details of the procedure and the context of the billing situation. The use of TC modifiers with code 33999 will require careful consideration of payer specific rules and guidelines.
- Fee Schedule : The historical fee schedule for 33999 varies greatly over time and across payers.Reimbursement rates are determined on a case-by-case basis based on comprehensive documentation and payer-specific policies.
- Specialties:Cardiac Surgery, Cardiovascular Surgery, Thoracic Surgery
- Place of Service:Inpatient Hospital, On Campus-Outpatient Hospital, Ambulatory Surgical Center