Summary & Overview
CPT 33468: Tricuspid Valve Repositioning and Plication for Ebstein Anomaly
CPT code 33468 denotes a specialized cardiac surgical procedure: tricuspid valve repositioning and plication to correct displacement of the septal and posterior leaflets in Ebstein anomaly. This code represents a targeted, corrective intervention for a congenital tricuspid valve malformation and is relevant nationally due to its role in managing a rare but clinically significant cardiac condition that often requires specialized surgical centers and multidisciplinary care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical settings of care, and the service type tied to this code. The publication summarizes common billing practices and benchmarking considerations, highlights policy and coverage considerations that affect access to specialized congenital valve repair, and outlines what to expect in claims processing for inpatient cardiac surgery procedures.
The report is intended for clinicians, coding professionals, and policy analysts seeking clarity on coding, coverage patterns, and operational implications for complex tricuspid valve repair. Data not available in the input will be explicitly noted in detailed sections.
Billing Code Overview
CPT code 33468 describes a surgical procedure for tricuspid valve repositioning and plication to correct displacement of the septal and posterior leaflets in Ebstein anomaly. This procedure addresses anatomical malpositioning of tricuspid valve leaflets to improve valve function and reduce regurgitation.
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Service type: Corrective cardiac surgery involving tricuspid valve repair
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Typical site of service: Inpatient hospital operating room or cardiac surgery center
Clinical & Coding Specifications
Clinical Context
A pediatric or adult patient with symptomatic Ebstein anomaly presents with tricuspid valve leaflet displacement causing significant tricuspid regurgitation, right atrial enlargement, exercise intolerance, cyanosis, or heart failure symptoms. Typical presentation includes progressive dyspnea on exertion, fatigue, palpitations, and possible recurrent arrhythmias. Diagnostic workup includes transthoracic and transesophageal echocardiography documenting apical displacement of the septal and posterior leaflets, right atrial enlargement, and severity of regurgitation; cardiac MRI or CT may be used for anatomic detail. Cardiology and cardiothoracic surgery evaluate operative candidacy after medical optimization.
The clinical workflow begins with outpatient cardiology evaluation, imaging, and preoperative risk stratification. Hospital admission occurs on the day of surgery or the day prior. Intraoperative transesophageal echocardiography guides repair. The operative procedure involves tricuspid valve leaflet mobilization, repositioning of the septal and posterior leaflets, and plication or annuloplasty as required to restore valve coaptation and reduce regurgitation. Postoperative care includes ICU monitoring, hemodynamic support, arrhythmia surveillance, and serial echocardiography prior to discharge. Follow-up occurs in cardiology and cardiothoracic surgery clinics with ongoing imaging and rhythm management as needed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default primary identifier |