Wiki Cardiac valve procedure

[mmachicote1@yahoo.com]

Hello-
Note sure if these are errors in my books or i'm missing something?
In my cpc study guide on page 139 under Cardiac Valve Procedures second column indicates "Code 33390...do not include cardiopulmonary bypass." In Cpt 2020 page 227 code 33390 states "...with cardiopulmonary bypass. "

Can someone help?
Thank you,
Michelle

 

[crystalg71]

Hi Michelle here is the full description of CPT code 33390.

CPT code 33390 is for Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; simple (ie, valvotomy, debridement, debulking, and/or simple commissural resuspension) ​

The provider creates an open incision in the chest through which he repairs a malfunctioning aortic valve with the heart placed in arrest (not beating) and blood circulation maintained by a machine, i.e., cardiopulmonary bypass (CPB). The provider performs this procedure to treat aortic stenosis.​

Clinical Responsibility​

After the patient is appropriately prepped and anesthetized, the provider creates an incision in the chest. He may create a sternotomy (cut through the breastbone) or go through the ribs to access the heart and great vessels. He incises the pericardium, the tissue surrounding the heart. He puts a clamp on the aorta and puts the heart into cardiac arrest — stops it from beating — and connects the patient to CPB, a machine which takes over the function of the heart and lungs and keeps oxygenated blood circulating throughout the body. He inspects the aortic valve. He cuts into the valve (valvotomy) and removes the scar tissue between the leaflets of the aorta with a scalpel (debridement). He removes all the diseased tissue he sees and reduces the bulk of the valve as necessary. He may need to secure the valve leaflets (cusps or flaps) back in their proper anatomical position (commissural resuspension). He then closes the incision in the aorta and removes the clamps. Finally, he stops any bleeding and weans (gradually discontinues) the patient from bypass, closing incisions made to establish the bypass. He checks for and controls any bleeding. He then closes the chest wall by suturing the layers of tissue together. He may place chest or drainage tubes before dressing the chest incision.​

Terminology​

Aortic valve: The cardiac valve connecting the heart to the aorta, the largest artery originating from heart, which supplies oxygenated blood to the body.

Open incision: A surgical approach that involves making a large enough incision that the provider can directly visualize the target anatomy.

Valve, a membranous structure in an organ or vein that can open and close to control the passage of fluid, blood, or other materials; the heart has four valves, the mitral, aortic, pulmonary, and tricuspid.​

Tips​

Code 33390 represents a simple valvotomy under cardiopulmonary bypass; for a more complex procedure, report 33391 (Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; complex [e.g., leaflet extension, leaflet resection, leaflet reconstruction, or annuloplasty]).​

Crystal Garrett CPC, CCC​

 

[fwnewbie]

What I think your study guide means is do not ALSO code the bypass as it's included in the valvuloplasty. The study guide is not the official descriptor so I would go with the 33390 as described in the cpt manual.