Summary & Overview
CPT 33390: Open Aortic Valve Repair with Cardiopulmonary Bypass
CPT code 33390 identifies open surgical repair of a malfunctioning aortic valve performed with cardiopulmonary bypass and cardiac arrest to treat aortic stenosis. This code captures a high-acuity cardiovascular procedure that has significant implications for hospital resource use, perioperative risk management, and reimbursement given its reliance on operating room time, cardiopulmonary bypass, and intensive postoperative care. Nationally, accurate coding of this procedure affects quality measurement, case-mix adjustment, and payment for complex cardiac surgery.
Key payers evaluated in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and coding overview of the surgical service, typical site-of-service expectations, and common modifiers associated with complex intraoperative and postoperative circumstances. The analysis highlights benchmarks for coding practice and utilization patterns where available, practical considerations for claims documentation, and recent policy or payer guidance that may affect coverage and prior authorization processes.
This summary equips billing managers, clinical coders, and policy analysts with the context needed to interpret claims involving 33390, understand payer coverage environments, and align documentation with coding standards for open aortic valve repair using cardiopulmonary bypass.
Billing Code Overview
CPT code 33390 describes an open surgical repair of a malfunctioning aortic valve performed through a chest incision with the heart placed in arrest (nonbeating) while blood circulation is maintained by cardiopulmonary bypass (CPB). The procedure is intended to treat aortic stenosis by repairing the native aortic valve.
Service type: Open cardiac surgical valve repair with cardiopulmonary bypass
Typical site of service: Inpatient hospital operating room or cardiac surgery suite
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with progressive exertional dyspnea, angina and syncope presents with severe calcific aortic stenosis confirmed by echocardiography (peak aortic jet velocity >4.0 m/s, mean gradient ≥40 mmHg, and aortic valve area ≤1.0 cm2). The cardiothoracic surgery team schedules an isolated surgical aortic valve replacement (SAVR) via median sternotomy. The patient is admitted to the inpatient cardiothoracic unit on the day of surgery. Under general anesthesia, the surgeon makes an open incision in the chest (median sternotomy), institutes cardiopulmonary bypass (CPB), arrests the heart with cardioplegia, excises the diseased aortic valve leaflets and places a prosthetic valve. Intraoperative transesophageal echocardiography confirms valve seating and function prior to weaning from CPB. The patient is transferred to the cardiac intensive care unit for postoperative monitoring, mechanical ventilation weaning, analgesia, hemodynamic stabilization, and early mobilization. Typical documentation includes preoperative history and physical, anesthesia record, cardiothoracic operative note describing CPB times and valve type/size, intraoperative TEE report, and postoperative progress notes including anticoagulation plan if a mechanical valve was implanted.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Routine performance (no modifier) | Use when standard billing requires an explicit 00 indicator per payer rules (rare). |