CPT code 33365 is used for the procedure of replacing an aortic valve through an open surgical approach.
CPT code 33365 is used to describe the procedure of replacing an aortic valve through an open surgical approach. This code is specifically assigned to the surgical intervention where the aortic valve, which is one of the heart's four valves, is replaced due to conditions such as aortic stenosis or aortic regurgitation. The procedure involves opening the chest to access the heart, removing the diseased valve, and replacing it with a prosthetic valve. This code is critical for accurate billing and documentation in the healthcare revenue cycle, ensuring that healthcare providers are reimbursed appropriately for the complex and resource-intensive nature of this cardiac surgery.
For the CPT code 33365, which pertains to the replacement of an aortic valve via an open procedure, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to complications or additional work that is not usually encountered.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was carried out.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures that are not typically reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used to indicate the collaborative effort.
5. Modifier 66 - Surgical Team: This modifier is applicable when a complex procedure requires the services of several physicians, often of different specialties, working together as a team.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when a procedure is performed by the same physician during the postoperative period of another procedure, but the procedure is unrelated to the original surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It's important for healthcare providers to use these modifiers correctly to avoid claim denials and ensure proper payment.
CPT code 33365, which involves a specific medical procedure, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining whether a particular CPT code is reimbursable. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals, and CPT code 33365 would be included in this schedule if it is deemed reimbursable.
Additionally, Medicare Administrative Contractors (MACs) are responsible for processing claims and making coverage determinations at the regional level. They may have specific local coverage determinations (LCDs) that influence whether CPT code 33365 is reimbursed in a particular area. Therefore, while CPT code 33365 can be reimbursed by Medicare, healthcare providers should verify its inclusion in the MPFS and consult with their respective MACs to ensure compliance with any regional policies or requirements.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including CPT code 33365, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
