Summary & Overview
CPT 33391: Aortic Valve Reconstruction, Open with Cardiopulmonary Bypass
CPT code 33391 represents open reconstruction of a severely malfunctioning aortic valve performed via a median sternotomy or other open chest approach with the heart arrested and cardiopulmonary bypass supporting circulation. This procedure addresses advanced aortic stenosis and is a core corrective surgery in adult cardiothoracic practice. Nationally, surgical aortic valve repair and reconstruction are significant for hospital surgical service lines, resource planning, and specialty cardiac care networks.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, expected site of service, and typical service line context for 33391. The publication provides benchmarking context and policy-relevant notes useful for billing teams, hospital administrators, and clinical leaders, including common modifier usage where applicable. It also outlines what to expect in claims processing and payer interactions at a high level.
The content covers clinical context for aortic valve reconstruction, common operational settings, and the elements relevant to coding and reimbursement workflows. Data not provided in the input, such as associated taxonomies, specific ICD-10 diagnosis codes, related CPT codes, and payer-specific coverage rules, are noted as unavailable in the input.
Billing Code Overview
CPT code 33391 describes an open surgical procedure to reconstruct a severely malfunctioning aortic valve. The operation is performed through an open incision in the chest with the heart arrested (not beating) and cardiopulmonary bypass (CPB) used to maintain circulation while the surgeon repairs the valve to treat aortic stenosis.
Service type: Open cardiac valve reconstruction (aortic), operative
Typical site of service: Inpatient hospital — operating room with cardiothoracic surgery capabilities and cardiopulmonary bypass support
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with symptomatic severe calcific aortic stenosis presents with progressive exertional dyspnea, syncope, and angina. Diagnostic workup includes transthoracic echocardiography showing an aortic valve area <1.0 cm2, peak gradient >64 mmHg, and reduced stroke volume. Coronary angiography excludes significant obstructive coronary disease. The cardiothoracic surgery team schedules an open surgical aortic valve replacement (SAVR) using cardiopulmonary bypass (CPB) with the heart arrested for valve excision and replacement.
Preoperative workflow: anesthesiology evaluation, informed consent, pre-op labs, crossmatch, and baseline imaging. Intraoperative workflow: median sternotomy, institution of CPB, aortic cross-clamp and cardioplegia for cardiac arrest, excision of the diseased native valve, implantation of a prosthetic valve (mechanical or bioprosthetic), de-airing, removal of cross-clamp, weaning from CPB, hemostasis, chest tube placement, and sternal closure. Postoperative workflow: ICU monitoring, anticoagulation management (if mechanical valve), pain control, and rehabilitation. Typical site of service is an inpatient operating room within a hospital. Service type: open cardiothoracic surgical procedure requiring cardiopulmonary bypass.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | (Not standard CMS modifier; institution-specific) | Data not available in the input — do not apply without payer guidance. |