Cardiology Coding Alert

Question: After prepping and anesthetizing the patient, my provider accessed the patient’s femoral artery by making a small incision in the groin area. They passed a compressed prosthetic aortic valve into the femoral artery and advanced it to the heart with the help of a catheter. My provider prepped the space with a balloon catheter, positioned the valve, and placed it at the site of the damaged aortic valve. They used fluoroscopy imaging to assist with navigating the vascular system and placing the valve. How should I report this service?

North Carolina Subscriber

Answer: This is an example of a TAVI/TAVR service, which is a transcatheter aortic valve implantation/transcatheter aortic valve replacement. Per the details you provided, you would report 33361 (Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach) on your claim.

Don’t miss: TAVI/TAVR requires two physicians, which you would represent by appending modifier 62 (Two surgeons) to 33361.

Coding tip: Code 33361 includes the work when performed, of percutaneous access, placing the access sheath, balloon aortic valvuloplasty, advancing the valve delivery system into position, repositioning the valve as needed, deploying the valve, temporary pacemaker insertion for rapid pacing and closure of the arteriotomy when performed, according to CPT^®. This code also includes an open arterial or cardiac approach.

Additionally, “Angiography, radiological supervision, and interpretation performed to guide TAVR/TAVI (eg, guiding valve placement, documenting completion of the intervention, assessing the vascular access site for closure) are included in these codes,” per CPT^®.