Summary & Overview
CPT 33475: Pulmonary Valve Replacement
CPT code 33475 represents surgical replacement of the pulmonary valve with a prosthetic valve. This cardiac surgical code is used for adults—frequently those with prior congenital heart defect repairs—who develop pulmonary regurgitation and resultant right ventricular hypertrophy. The procedure is clinically significant because it addresses valve incompetence that can progress to right-sided heart failure and impacts resource use in inpatient cardiac surgery.
Key payers in national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when the procedure is indicated, typical sites of service, and the payer mix used in benchmarking. The publication also summarizes common billing modifiers and related administrative details where available and notes when specific data elements are not provided.
This overview is aimed at clinicians, coding professionals, and policy analysts who need a concise reference to the clinical intent of the code, its role in managing late sequelae of congenital heart disease, and the payer landscape affecting reimbursement and utilization at a national level.
Billing Code Overview
CPT code 33475 describes a surgical procedure in which the provider removes the native pulmonary valve and replaces it with an artificial (prosthetic) pulmonary valve. This procedure is typically performed to correct pulmonary regurgitation and its sequelae, such as right ventricular hypertrophy, often in adults who previously underwent congenital heart defect repairs as infants.
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Service type: Surgical cardiac valve replacement
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Typical site of service: Inpatient hospital operating room with postoperative inpatient care
Clinical & Coding Specifications
Clinical Context
A 42-year-old adult with a history of childhood repair of tetralogy of Fallot presents with progressive exertional dyspnea and recurrent arrhythmia. Echocardiography and cardiac MRI demonstrate severe pulmonary regurgitation with right ventricular enlargement and dysfunction. After multidisciplinary review, the cardiothoracic surgery team schedules a pulmonary valve replacement with a prosthetic valve. The patient is admitted to a tertiary care hospital's cardiothoracic operating suite. Preoperative workflow includes cardiac imaging, laboratory testing, anesthesia evaluation, and informed consent. Intraoperative steps include median sternotomy (or redo sternotomy), cardiopulmonary bypass, excision of the native or dysfunctional pulmonary valve, and implantation of a bioprosthetic or mechanical valve. Postoperative care occurs in the cardiac intensive care unit with hemodynamic monitoring, chest tube management, pain control, anticoagulation planning (if mechanical valve), and physical therapy, followed by discharge planning and outpatient cardiology follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier required / general clinical reporting | Not commonly appended; represents default reporting when no modifier applies |
11 |