Summary & Overview
CPT 33426: Mitral Valve Valvuloplasty with Cardiopulmonary Bypass
CPT code 33426 represents a critical surgical procedure: valvuloplasty of the mitral valve with cardiopulmonary bypass. This operation is essential for patients with mitral valve disease, including stenosis and insufficiency, and is performed in an inpatient hospital setting. The code is widely recognized across major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, underscoring its clinical and reimbursement significance.
This publication provides a comprehensive overview of 33426, covering payer coverage, clinical context, and related coding benchmarks. Readers will gain insight into the procedure's role in cardiothoracic surgery, typical billing practices, and associated modifiers. The summary also highlights relevant taxonomies and ICD-10 diagnoses, offering a clear understanding of how this code fits within broader cardiovascular care. Policy updates and coding trends are discussed to inform stakeholders about current standards and expectations for mitral valve repair procedures. The analysis is designed for a national audience, supporting healthcare professionals, administrators, and policy makers in navigating the complexities of surgical billing and reimbursement for mitral valvuloplasty.
CPT Code Overview
CPT code 33426 describes a valvuloplasty of the mitral valve performed with cardiopulmonary bypass. This procedure is a surgical intervention aimed at repairing the mitral valve to restore proper function, typically indicated for patients with mitral valve disease such as stenosis or insufficiency. The service falls under surgical procedures on the mitral valve and is most commonly performed in an inpatient hospital setting (Place of Service 21). This complex surgery requires specialized expertise and resources, reflecting its importance in the management of advanced cardiovascular conditions.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting with symptomatic mitral valve disease, such as mitral regurgitation or stenosis. The patient may experience symptoms like shortness of breath, fatigue, or palpitations. After diagnostic evaluation, including echocardiography, the patient is scheduled for surgical mitral valvuloplasty with cardiopulmonary bypass. The procedure is performed in an inpatient hospital setting, typically by a cardiothoracic surgeon, sometimes with assistance from another surgeon or surgical assistant. The clinical workflow includes preoperative assessment, intraoperative repair of the mitral valve, and postoperative care in a cardiac unit.
Coding Specifications
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Modifier
62(Two Surgeons): Used when two surgeons perform distinct parts of the procedure, each acting as a primary surgeon. -
Modifier
80(Assistant Surgeon): Used when an assistant surgeon provides surgical assistance during the procedure. -
Provider Taxonomies:
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