CPT® Code 33997

Removal of percutaneous right heart ventricular assist device, venous cannula, at separate and distinct session from insertion

The CPT® Code 33997 refers to the removal of a percutaneous right heart ventricular assist device (RVAD) venous cannula, which is performed at a separate and distinct session from the insertion of the device. A right ventricular assist device is a mechanical pump designed to provide circulatory support for patients experiencing acute right heart failure. This condition may arise due to various complications, including myocardial ischemia, pulmonary embolism, or postcardiotomy syndrome. The RVAD functions by pumping blood from the right atrium or ventricle into the pulmonary artery, thereby facilitating blood flow to the lungs and relieving pressure on the right side of the heart. The procedure for placing an RVAD involves the insertion of two cannulas: one positioned in the right atrium and the other in the pulmonary artery. This is typically achieved through a percutaneous approach, utilizing fluoroscopic guidance and heparinization to ensure proper placement and minimize complications. The inflow cannula is usually inserted via the femoral vein, while the outflow cannula is placed through the right internal jugular vein. The correct positioning of these cannulas is confirmed through imaging techniques such as fluoroscopy and transesophageal echocardiogram. When the time comes to remove the RVAD, it is crucial to manage anticoagulation carefully as the patient is weaned off the device's support. The removal process involves taking out the cannulas that were previously inserted, which is done in a controlled manner to ensure patient safety and minimize the risk of complications. This code specifically addresses the removal of the venous cannula, highlighting the importance of performing this procedure in a separate session from the initial insertion to ensure proper documentation and billing practices.