Summary & Overview
CPT 33422: Open Mitral Valve Repair Under Cardiopulmonary Bypass
CPT code 33422 denotes an open mitral valve repair procedure performed under cardiopulmonary bypass to release a narrowed or stiff mitral valve. This code captures resource-intensive cardiac surgery with significant implications for inpatient surgical capacity, perioperative care pathways, and national procedural volume and cost monitoring.
Key payers considered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of clinical context and typical care setting, plus an outline of benchmarking and policy-relevant topics frequently associated with this service: payer coverage patterns, coding and billing considerations, utilization benchmarks, and implications for hospital surgical resource planning.
The content that follows provides clinical context for 33422, identifies where the procedure is typically performed, and summarizes the elements stakeholders monitor when evaluating access, utilization, and reimbursement for open mitral valve release under cardiopulmonary bypass. Data not available in the input will be noted as such in relevant sections.
Billing Code Overview
CPT code 33422 describes an open surgical procedure to relieve stenosis and rigidity of the mitral valve. In this operation the provider opens the chest and surgically releases the stiffened mitral valve while the patient is supported by an artificial heart–lung machine (cardiopulmonary bypass).
Service type: Open cardiac valve repair (mitral valve commissurotomy/valvulotomy)
Typical site of service: Inpatient hospital — operating room (cardiac surgery suite) with cardiopulmonary bypass support
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with symptomatic rheumatic mitral stenosis presents with exertional dyspnea, decreased exercise tolerance, and a new diastolic murmur. Echocardiography demonstrates a heavily calcified, stenotic mitral valve with commissural fusion and a mean transmitral gradient >10 mm Hg and reduced valve area consistent with severe mitral stenosis. Coronary angiography is obtained preoperatively to assess coronary anatomy. The patient is scheduled for an open mitral valve commissurotomy/valvulotomy performed on cardiopulmonary bypass by a cardiothoracic surgeon. The clinical workflow includes preoperative evaluation and optimization, general endotracheal anesthesia, median sternotomy, institution of cardiopulmonary bypass, direct inspection and surgical release of fused commissures and subvalvular apparatus (mitral valve repair/commissurotomy), intraoperative transesophageal echocardiography to assess valve function, weaning from bypass, chest closure, and postoperative ICU monitoring for hemodynamics, rhythm, anticoagulation, and respiratory support. Discharge planning includes anticoagulation counseling if indicated, wound care, and follow-up with cardiology and cardiothoracic surgery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no circumstance requires an additional modifier. |