Summary & Overview
CPT 33367: Cardiopulmonary Bypass During Primary TAVI/TAVR
CPT code 33367 denotes the use of cardiopulmonary bypass (CPB) with percutaneous peripheral arterial and venous cannulation during the primary transcatheter aortic valve implantation/replacement (TAVI/TAVR) procedure. Nationally, this code is relevant for documenting complex intraoperative support when CPB is required to manage hemodynamics or procedural complications during TAVI/TAVR. Accurate use of the code affects procedural reporting and the clinical record for high-acuity structural heart interventions.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for CPB use in transcatheter valve procedures, typical sites of service, and the coding scope for percutaneous peripheral cannulation. The publication summarizes expected billing considerations and common modifiers used with this procedure code. It also outlines where to look for payer-specific coverage policies and documentation requirements.
This analysis is intended for a national audience of clinicians, billing professionals, and policy analysts who need concise guidance on what CPT code 33367 represents, why it matters for reporting complex TAVI/TAVR cases, and which payers commonly address coverage and documentation for intraoperative CPB support.
Billing Code Overview
CPT code 33367 indicates that the provider uses cardiopulmonary bypass (CPB) during the primary transcatheter aortic valve implantation/replacement (TAVI/TAVR) service. This code is specific to CPB performed using percutaneous peripheral arterial and venous cannulation.
Service type: Intraoperative cardiopulmonary bypass during primary TAVI/TAVR
Typical site of service: Hospital operating room or hybrid cardiac catheterization suite where transcatheter aortic valve procedures are performed
Clinical & Coding Specifications
Clinical Context
A 78-year-old patient with symptomatic severe aortic stenosis is evaluated for transcatheter aortic valve implantation/replacement (TAVI/TAVR). Due to complex vascular anatomy and anticipated hemodynamic instability during valve deployment, the interventional cardiology and cardiothoracic surgery teams plan a transfemoral TAVR with standby cardiopulmonary bypass (CPB) established via percutaneous peripheral arterial and venous cannulation. The patient is admitted to the hospital the morning of the procedure, undergoes pre-procedure assessment including review of anticoagulation, vascular ultrasound of the groins, and anesthesia evaluation. In the hybrid operating room, vascular access is obtained percutaneously in the common femoral artery and femoral vein for CPB cannulation. General anesthesia is used, transesophageal echocardiography (TEE) monitors valve positioning and cardiac function, and fluoroscopic guidance is used for valve delivery. CPB is initiated only if required for hemodynamic support or complications; coding captures the use of CPB via peripheral percutaneous cannulation when performed during the primary TAVR service. Post-procedure care includes ICU or step-down monitoring for hemodynamics, vascular site surveillance, and anticoagulation management prior to discharge planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | Use when two surgeons work together as primary surgeons for portions requiring distinct expertise during the same operative session. |