Cardiology Coding Alert

You Be the Coder:

Focus on Type of Aortic Valve for Code Selection

Question: After giving general anesthesia to the patient, my surgeon made an incision through the sternum and opened the pericardium. My surgeon put the patient on a heart-lung machine and made an incision in the aorta. They then removed the aortic valve and placed an artificial valve in its place. Finally, they closed the incision in the aorta and removed the heart-lung machine. My surgeon performed an echocardiogram to check whether the new valve is functioning properly and transferred the patient to the recovery room. Which CPT® code should I report for this procedure?

Alabama Subscriber

Answer: You should report 33405 (Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve).

Don’t miss: Always make sure you read the documentation carefully to choose the appropriate code for the specific valve your cardiologist used because there are different ones. Use 33405 when your cardiologist uses a prosthetic valve. However, you would report 33406 (Replacement, aortic valve, open, with cardiopulmonary bypass; with allograft valve (freehand)) if your cardiologist used an allograft valve, which is a tissue graft harvested from one person for another). And you should report 33410 (Replacement, aortic valve, open, with cardiopulmonary bypass; with stentless tissue valve) if your cardiologist uses an artificial stentless valve, which is an artificial valve not attached to a stent or frame.

When your cardiologist performs a reoperation, report add-on code +33530 (Reoperation, coronary artery bypass procedure or valve procedure, more than 1 month after original operation [List separately in addition to code for primary procedure]) in addition to 33405. Reporting +33530 will allow your cardiologist to garner payment for the increased difficulty they face when redoing a procedure.

During surgery, your cardiologist may repair or replace valves. When they repair a valve, they will open a narrowed valve or reinforce a faulty valve. If they can’t repair a valve, they must remove it. If this is the case, your cardiologist will replace the faulty valve with a prosthetic one and you should report a code such as 33413 (Replacement, aortic valve; by translocation of autologous pulmonary valve with allograft replacement of pulmonary valve (Ross procedure)), 33430 (Replacement, mitral valve, with cardiopulmonary bypass), 33465 (Replacement, tricuspid valve, with cardiopulmonary bypass), or 33475 (Replacement, pulmonary valve), for the specific type of valve replaced.