Wiki Valve in Vale TAVR -- Unlisted or Established?

[jtuominen]

If a patient has a pre-existing bioprosthetic aortic valve that isn't functioning properly anymore, and patient presents to have TAVR to place new prosthesis over the old one, would you go with 33999 or established code? (ie 33361 for example).
I know that guidance has been put forth to use 33999 for this scenario for mitral valve in valve replacements. Wondering if people follow suit with aortic valves.

Thanks.

 

[jtuominen]

Just in case anyone takes a gander at this

Im going with 33361 due to CPT Assistant Jan 2013 page 6 which suggests a patient can present with either a native or prosthetic valve at the time of TAVR.

Question: When replacing an aortic valve, what determines when to report code 33405, Replacement, aortic valve, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve, versus TAVR/TAVI codes 33361-33365?

Answer: Code 33405 describes the replacement of an aortic valve using an invasive open surgical technique in which the native or prosthetic valve is removed and replaced by a prosthetic valve, which is sewn into place by the surgeon. In the TAVR/TAVI procedures, the preexisting native or prosthetic valve is not removed.

The TAVR/TAVI codes 33361-33365 and 0318T describe the replacement of the valve using a transcatheter delivery technique for the implantation of a prosthetic valve within the pre-existing valve.