Summary & Overview
CPT 33928: Removal and Replacement of Implanted Artificial Heart
CPT code 33928 covers surgical removal of a previously implanted artificial heart and implantation of a replacement artificial heart, used as either temporary support until a donor heart is available or as permanent mechanical circulatory support for patients ineligible for transplant. This high-acuity cardiothoracic procedure has significant implications for hospital resource use, care coordination, and device management nationally.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines coverage and billing considerations across these payers, typical sites of service, and clinical context for use of device exchange. It also summarizes common modifier usage and highlights areas where policy updates or payer-specific requirements commonly affect claims processing.
Readers will find a concise clinical description, expected clinical setting, and payer landscape overview relevant to hospitals, cardiothoracic surgeons, and billing professionals. The content provides benchmarks and policy-focused observations to inform coding accuracy and administrative planning. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 33928 describes surgical removal of a previously implanted artificial heart with implantation of a replacement artificial heart. This procedure is performed when an implanted device has failed or when a newer model is required, and the replacement may serve as a bridge to transplant or as permanent mechanical circulatory support for patients who are not transplant candidates.
-
Service type: Open cardiothoracic surgical procedure for mechanical circulatory support device exchange
-
Typical site of service: Inpatient hospital setting, often performed in an operating room with cardiothoracic surgery and intensive postoperative care
Clinical & Coding Specifications
Clinical Context
A typical patient for 33928 is an adult with a previously implanted total artificial heart (TAH) who now requires replacement of that device. Common scenarios include device mechanical failure, device-related infection unresponsive to conservative therapy, progressive device thrombosis, or the need to upgrade to a newer model for improved hemodynamic support. The procedure is typically performed in an inpatient tertiary care center with a cardiothoracic surgery program and advanced heart-failure services.
A realistic workflow: the patient is admitted to the cardiac intensive care unit for evaluation. Preoperative assessment includes hemodynamic monitoring, transesophageal echocardiography, laboratory studies (including coagulation profile and blood cultures if infection suspected), and crossmatching for blood. The cardiothoracic surgery team, perfusionists, anesthesia, and device specialists plan the operative strategy. Under general anesthesia, the prior device is explanted and the new TAH implanted with cardiopulmonary bypass support as needed. Postoperatively the patient returns to the cardiac ICU for ventilatory and circulatory support, device surveillance, anticoagulation management, and infectious disease involvement if infection was present. If the replacement is temporary while awaiting transplant, coordination with the transplant team and donor allocation processes follows. For patients unsuitable for transplant, long-term device management and outpatient follow-up are arranged.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|