Summary & Overview
CPT 33440: Aortic Valve Replacement with Pulmonary Autograft and Conduit
CPT code 33440 denotes an advanced open cardiac surgery that replaces the aortic valve with the patient’s pulmonary valve, enlarges the aortic annulus/LVOT, and reconstructs the pulmonary valve position with a valved conduit. This procedure is clinically significant for patients with complex aortic valve disease, congenital abnormalities, or situations where a durable autograft is preferred. Nationally, use of this code signals high-acuity inpatient surgical care with substantial resource use, perioperative risk, and specialized cardiac surgical capacity. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent and hospital-based service implications, typical sites of service, common modifiers associated with surgical billing, and guidance on where to locate related policy and coverage criteria. The publication also summarizes benchmarking and utilization context, coding considerations relevant to inpatient cardiac surgery, and links to clinical and payer policy resources. Data not provided in the input — such as associated taxonomies, specific ICD-10 diagnoses, and payer-specific reimbursement rates — are noted as unavailable and are not fabricated.
Billing Code Overview
CPT code 33440 describes a complex cardiac surgical procedure in which the surgeon replaces the aortic valve using the patient’s own pulmonary valve (the Ross procedure variant), enlarges the aortic annulus/left ventricular outflow tract (LVOT), and replaces the translocated pulmonary valve with a valved conduit. This operation combines autograft aortic valve replacement, annular enlargement, and right ventricular outflow tract reconstruction with a prosthetic conduit.
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Service type: Open cardiothoracic surgical valve reconstruction and conduit placement
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Typical site of service: Inpatient hospital, operating room, with postoperative care in a cardiac intensive care unit or monitored inpatient setting
Clinical & Coding Specifications
Clinical Context
A typical patient is a 12–40 year-old with congenital or acquired aortic valve disease (eg, severe aortic stenosis or regurgitation) where the Ross procedure is indicated. The patient presents with progressive exertional dyspnea, chest pain, or heart failure symptoms and has diagnostic testing including transthoracic echocardiography showing a dysfunctional aortic valve and a competent pulmonary valve suitable for autograft. Preoperative workup includes cardiac catheterization to assess coronary anatomy, cross-sectional imaging as needed, and routine surgical clearance.
In the operating room under general anesthesia, the cardiothoracic surgical team performs median sternotomy, cardiopulmonary bypass, and aortic root mobilization. The diseased aortic valve is excised and replaced with the patient’s pulmonary valve (the autograft). The aortic annulus/LVOT is enlarged as required (annular enlargement or root replacement technique). The native pulmonary valve is then replaced with a valved conduit (homograft or prosthetic valved conduit). Postoperative care includes ICU monitoring, vasoactive support as needed, anticoagulation planning, serial echocardiography, and scheduled follow-up for conduit surveillance and autograft function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Routine reporting when no modifier applies |