Summary & Overview
CPT 33418: Percutaneous Mitral Valve Repair With Bypass
CPT code 33418 represents percutaneous repair of a narrowed, stiff mitral valve performed with cardiopulmonary bypass and possible prosthesis placement. This invasive, image-guided cardiac procedure addresses mitral stenosis or structural abnormalities that restrict flow between the left atrium and left ventricle. Nationally, the code matters for hospital cardiovascular service lines, procedural reimbursement, and indexing of transcatheter mitral interventions in specialty reporting.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise outline of clinical context for the procedure, typical site-of-service considerations, and the payer landscape covered in the analysis. The publication summarizes benchmark metrics, common billing modifiers encountered, and related policy or coding clarifications relevant to facilities and cardiovascular clinicians. It also provides links between the clinical procedure and coding practice to support accurate claims submission and administrative documentation.
The content is intended for national audiences including hospital administrators, cardiothoracic program managers, and clinical coders seeking clear context on CPT code 33418, its clinical application, and payer considerations.
Billing Code Overview
CPT code 33418 describes a surgical procedure to repair a narrowed and stiff mitral valve using a percutaneous approach. The procedure involves transcatheter access through the skin and may include transseptal puncture of the heart to reach the mitral valve. The provider releases the stiff valve while the patient is supported on an artificial heart–lung machine (cardiopulmonary bypass) and may place a prosthesis as part of the repair.
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Service type: Percutaneous mitral valve repair/replacement performed with cardiopulmonary bypass support
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Typical site of service: Hospital operating room or hybrid cardiac catheterization lab with cardiothoracic surgical capability
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with symptomatic rheumatic mitral stenosis presents with exertional dyspnea, decreased exercise tolerance, and signs of left atrial enlargement on echocardiography. Diagnostic transthoracic and transesophageal echocardiography demonstrate a thickened, fused mitral valve with a reduced mitral valve area and elevated mean diastolic gradient, with anatomy potentially suitable for percutaneous intervention. The interventional cardiology team schedules a percutaneous mitral valvotomy/valvuloplasty performed in a cardiac catheterization laboratory or hybrid operating room under general anesthesia or conscious sedation. Vascular access is obtained percutaneously (commonly via the femoral vein), a transseptal puncture may be performed to access the left atrium, and balloon dilation or other percutaneous techniques are used to relieve stenosis. The procedure may be performed on cardiopulmonary bypass if surgical conversion is required, and prosthetic valve placement may occur if repair is not feasible. Typical peri-procedural workflow includes pre-procedure informed consent, anticoagulation management, intraprocedural transesophageal echocardiography guidance, hemodynamic monitoring, post-procedure observation in a cardiac post-anesthesia care unit or intensive care unit, and discharge planning with follow-up echocardiography and anticoagulation management as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Primary procedure | When this percutaneous mitral valvotomy is the principal service on the claim |