Cardiology Coding Alert

Question: The cardiologist performed a transcatheter pulmonary valve implantation (TPVI) via a percutaneous approach in a patient. According to the documentation, the cardiologist placed a stent at the valve site to keep it open before performing the replacement. Which CPT^® code should I report for this procedure?

Florida Subscriber

Answer: You should report 33477 (Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed) for this procedure.

CPT^® offers very specific rules about how to correctly report 33477:

• Rule 1: You should only report 33477 once per session.
• Rule 2: You should never report 33477 in conjunction with codes 76000, 93451, 93453-93461, 93531-93533, +93563, and +93566-+93568 for angiography essential to the TPVI.
• Rule 3: You should never report 33477 in conjunction with 37236, +37237, 92997, and +92998 for pulmonary artery angioplasty/valvuloplasty or stenting within the prosthetic valve delivery site.

Additionally, many services are included within the work of a 33477 procedure, so you cannot report these services separately.

For example, code 33477 includes the work of the percutaneous access, access sheath placement, advancing the repair device delivery system into position, repositioning the repair device as needed, and deploying the repair device(s), when performed.

The angiography, radiological supervision, and interpretation performed to guide the TPVI are all included in the 33477 service.

Also, code 33477 includes all cardiac catherization, intraprocedural contrast injections, fluoroscopic radiological supervision and interpretation, and imaging guidance.

Finally, code 33477 includes the percutaneous balloon angioplasty of the conduit/treatment zone, valvuloplasty of the pulmonary valve conduit, and deployment of the stent within the pulmonary conduit or an existing bioprosthetic pulmonary valve, when performed.