Summary & Overview
CPT 33460: Tricuspid Valvectomy (Excision of Tricuspid Valve)
CPT code 33460 represents a tricuspid valvectomy — the surgical excision of the tricuspid valve often indicated for severe tricuspid regurgitation, frequently associated with infective endocarditis and valve vegetations. As a high-acuity cardiac surgical procedure, it has implications for inpatient surgical capacity, perioperative management, and reimbursement categorization at a national level.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find national benchmarks for utilization and reimbursement frameworks, an overview of clinical indications and coding context, and policy-relevant considerations that affect coverage and billing for complex cardiac surgery. The publication summarizes how CPT code 33460 is positioned relative to related valve procedures and what billing teams and hospital administrators need to track for payer submission and audit readiness.
The report provides clinical context around indications and typical care settings, practical coding notes where available, and summaries of payer contract and coverage patterns. Data not available in the input is explicitly flagged where applicable.
Billing Code Overview
CPT code 33460 describes a valvectomy (excision of the tricuspid valve) performed to treat significant tricuspid regurgitation, commonly due to vegetations from infective endocarditis. The procedure involves surgical removal of the native tricuspid valve tissue.
Service type: Surgical — cardiac valve surgery
Typical site of service: Inpatient hospital — operating room with postoperative inpatient care
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient presents with fever, new onset murmur, and positive blood cultures for Staphylococcus aureus. Echocardiography demonstrates large mobile vegetations on the tricuspid valve with severe tricuspid regurgitation and recurrent septic pulmonary emboli despite targeted intravenous antibiotics. After multidisciplinary review, the cardiothoracic surgery team schedules operative management. In the operating room under general anesthesia, the surgeon performs a tricuspid valvectomy (CPT 33460) with excision of the infected valve tissue. The intraoperative workflow includes median sternotomy, cardiopulmonary bypass, inspection of the right-sided structures, excision of the tricuspid valve leaflets and infected tissue, assessment for concomitant procedures, and placement of temporary measures (e.g., right atrial repair or patching) as indicated. Postoperative care involves intensive care monitoring, continued intravenous antimicrobial therapy guided by infectious disease, serial echocardiography, and planning for possible delayed valve replacement if hemodynamics and infection control allow.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, and complexity substantially exceed typical for 33460 due to extensive debridement or complex anatomy |
23 | Unusual anesthesia | Use when medically necessary anesthesia is required but not normally used for this procedure |
26 | Professional component | Use if reporting only the physician's professional component for a separately payable service related to the procedure (rare for 33460) |
50 | Bilateral procedure | Not typically applicable to cardiac valve excision; reserved for paired organs when relevant |
51 | Multiple procedures | Use when 33460 is reported with additional unrelated surgical procedures during the same operative session |
52 | Reduced services | Use when the procedure is partially reduced or not completed as planned (e.g., aborted excision) |
53 | Discontinued procedure | Use when the procedure is started but terminated due to extenuating circumstances before completion |
62 | Two surgeons | Use when two surgeons of different specialties perform distinct portions of the operation concurrently |
63 | Procedure performed on infants less than 4 kg | Use when applicable to neonates/small infants undergoing valvectomy |
66 | Surgical team (multispecialty) | Use when procedure is performed by a surgical team that meets payer criteria for team reporting |
78 | Return to OR for related procedure during global period | Use when the patient returns to the OR for a related procedure during the global period after 33460 |
80 | Assistant surgeon | Use when an assistant surgeon is required and documented |
81 | Minimum assistant surgeon | Use when minimal assistance is documented and payer accepts this modifier |
82 | Assistant surgeon when qualified resident absent | Use when a qualified resident is unavailable and an assistant is required |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207L00000X | Cardiothoracic Surgery | Primary specialty performing tricuspid valvectomy and complex cardiac valve operations |
| 207PS0123X | Cardiac Surgery | Cardiac surgeons with focus on valve surgery and infective endocarditis cases |
| 207R00000X | Thoracic Surgery | Thoracic surgeons who participate in open cardiac procedures depending on institution |
| 2080P0207X | Cardiovascular Disease (Cardiology) | Cardiologists involved in diagnosis, perioperative management, and echocardiographic assessment |
| 363L00000X | Infectious Disease | Infectious disease specialists who direct perioperative antimicrobial therapy and stewardship |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I33.0 | Acute and subacute infective endocarditis | Primary indication when vegetations destroy the tricuspid valve requiring excision |
I39 | Endocarditis and heart valve disorders in diseases classified elsewhere | Used when endocarditis occurs as a manifestation of another systemic infectious process |
I07.1 | Rheumatic tricuspid stenosis | Chronic valvular disease that can contribute to tricuspid dysfunction; less common indication for valvectomy |
I34.1 | Nonrheumatic tricuspid regurgitation | Direct diagnosis for severe regurgitation that may necessitate valve intervention |
I97.1 | Postcardiotomy syndrome (if applicable) | Potential postoperative complication relevant to perioperative coding and management |
J85.1 | Abscess of lung and mediastinum (septic emboli complication) | Represents septic pulmonary emboli that can accompany tricuspid valve endocarditis and influence surgical urgency |
A41.9 | Sepsis, unspecified organism | Reflects systemic infection severity that often accompanies infective endocarditis and impacts perioperative care |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
33405 | Repair of tricuspid valve, annuloplasty, with prosthetic ring or band | Performed when valve can be repaired instead of excised; may be an alternative or subsequent procedure if valve salvage is feasible |
33430 | Replacement, tricuspid valve, with tissue graft | Used when definitive valve replacement is performed at the same operation or planned after infection control |
33440 | Replacement, tricuspid valve, with mechanical prosthesis | Used when mechanical valve replacement is chosen for durable fixation after excision |
33970 | Extracorporeal membrane oxygenation (ECMO) | May be required postoperatively for severe right heart failure or refractory cardiopulmonary support following valve excision |
93503 | Right heart catheterization, diagnostic, with measurement of hemodynamics | Performed preoperatively or intraoperatively to assess right-sided pressures and guide surgical planning |
93306 | Echocardiography, transthoracic, real-time with 2D imaging and M-mode (complete) | Used preoperatively and postoperatively for assessment of valve pathology and cardiac function |