Summary & Overview
CPT 33425: Open Mitral Valve Repair with Cardiopulmonary Bypass
CPT code 33425 represents an open mitral valve repair procedure performed with cardiopulmonary bypass to dilate a stenosed mitral valve. This high-acuity cardiac surgery is typically delivered in a hospital operating room with cardiothoracic surgical and perfusion teams. Nationally, procedures coded with CPT code 33425 are significant due to their resource intensity, implications for surgical quality metrics, and impact on inpatient cardiac surgery volumes and costs.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, payer coverage considerations and common modifiers used in billing, and an overview of typical sites of service. The publication also summarizes benchmarks relevant to utilization and reimbursement patterns, highlights important coding nuances for hospital billing lines, and outlines areas where policy updates and payer-specific edits commonly affect claim adjudication.
This summary provides clinicians, coding professionals, and policy analysts with a focused briefing on CPT code 33425: what the code denotes, why it matters in hospital-based cardiac care, and which payers and coding practices are most relevant for claims and policy review. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 33425 describes an open heart mitral valve repair procedure performed to dilate a stenosed mitral valve. The procedure uses cardiopulmonary bypass with a heart–lung machine to reroute circulation and provide a bloodless, motionless field while the surgeon repairs or dilates the mitral valve.
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Service type: Cardiac surgery — open mitral valve repair with cardiopulmonary bypass
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Typical site of service: Hospital inpatient operating room with cardiothoracic surgical team and cardiac perfusion support
Clinical & Coding Specifications
Clinical Context
A 67-year-old patient with progressive exertional dyspnea, a history of rheumatic heart disease, and echocardiography demonstrating severe mitral stenosis with a mean gradient >10 mmHg and restricted leaflet mobility is admitted for surgical mitral valve repair with cardiopulmonary bypass. Preoperative workup includes coronary angiography, transthoracic and transesophageal echocardiography, complete blood count, coagulation profile, and anesthesiology assessment. The procedure is performed in an inpatient operating room with general endotracheal anesthesia. Cardiopulmonary bypass is initiated via a heart–lung machine to provide circulatory and respiratory support while the surgeon performs mitral valve exposure through a median sternotomy, excises calcific or fibrotic tissue, performs commissurotomy or leaflet repair, and, if indicated, places an annuloplasty ring. Postoperative management occurs in the cardiothoracic intensive care unit with hemodynamic monitoring, ventilatory support as needed, anticoagulation management, and serial echocardiography to assess repair success and detect complications such as residual stenosis, regurgitation, bleeding, or arrhythmia. Typical length of stay is 5–10 days depending on recovery and comorbidities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Medical attachment — specific carrier use | Use only if payer requires a null/default modifier per carrier policy. |