Cardiac Phenotype Flow Chart

Start with all cases. Compile a list of all procedure types that the case may qualify for using steps 1-4. If the Obstetric Anesthesia Type phenotype is also triggered, the case is considered non-cardiac.

Step 1: Determine if case fits Open Cardiac criteria

• Exclude if:
  • Arterial line is not present (Arterial Line Used phenotype)
  • Case duration <120 minutes
  • Anesthesia CPT: 00500-00540 thoracic procedures for non-cardiac surgeries
  • Anesthesia CPT: 00550 sternal debridement
  • Anesthesia CPT: 00796 for liver transplant
  • Anesthesia CPG: 00868 for kidney transplant
  • Anesthesia CPT:  01990 for organ harvest
  • Anesthesia CPT: 00700-00797 for upper abdominal procedures (unless a predicted anesthesia CPT is 00560-00580 is also present)
  • Procedural service is: 
    • 80016 Medical-Cardiology
    • 80017 Medical-Gastroenterology
    • 80044 Pediatric Cardiology
    • 80003: neurosurgery
    • 80009: orthopedics
    • 80023: urology
    • 80033: pediatric neurosurgery
    • 80034: pediatric orthopedics
    • 80035: pediatric urology
• Include if:

  1. One of these surgical CPTs are present

     Cardiac Surgical CPT Code	Text description of Surgical CPT code (CPT Code Range 33016- 33999)
     33020-33100	Surgical Procedures on the Pericardium **except 33025**
     33120-33130	Excision Procedures of Cardiac Tumor
     33140-33141	Transmyocardial Revascularization Procedures
     33300-33315	Surgical Procedures on the Heart (Including Valves) and Great Vessels
     33321-33322	Surgical Procedures on the Heart (Including Valves) and Great Vessels Continued
     33335	Surgical Procedures on the Heart (Including Valves) and Great Vessels Continued
     33390-33417	Surgical Procedures on Cardiac Valves Cont.
     33422-33471	Surgical Procedures on Cardiac Valves Cont.
     33474-33476	Surgical Procedures on Cardiac Valves Cont.
     33478	Surgical Procedures on Cardiac Valves Cont.
     33496	Other Cardiac Valvular Procedures
     33500-33507	Coronary Artery Anomaly Procedures
     33508	Endoscopy Procedures on the Heart and Pericardium
     33510-33516	Venous Grafting Only for Coronary Artery Bypass
     33517-33530	Combined Arterial-Venous Grafting for Coronary Bypass
     33533-33548	Arterial Grafting for Coronary Artery Bypass
     33572	Coronary Endarterectomy Procedures
     33600-33622	Repair Procedures for Single Ventricle and Other Complex Cardiac Anomalies
     33641-33697	Repair Procedures for Septal Defect
     33702-33722	Repair Procedures for the Sinus of Valsalva
     33724-33732	Repair Procedures for Venous Anomalies
     33735-33768	Shunting Procedures on the Heart and Pericardium
     33770-33783	Repair Procedures for Transposition of the Great Vessels
     33786-33788	Repair Procedures for Truncus Arteriosus
     33800-33853	Repair Procedures for Aortic Anomalies
     33858-33877	Repair Procedures for Thoracic Aortic Aneurysm
     33910-33926	Surgical Procedures on the Pulmonary Artery
     33927-33945	Heart/Lung Transplantation Procedures
     33975-33983	Cardiac Assist Procedures

      

  2. If the above surgical CPTs are NOT present, consider the following anesthesia CPT codes with associated parameters

     • Anesthesia CPTs:
       • 00560 - Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator
         • Include in Open Cardiac if Anesthesia CPT is 00560, no surgical CPTs are present, and procedure text does NOT include “transcatheter”, “TAVR”, “MitraClip”, “Mitra Clip”, “Mitral Clip”, “Mitral Valve Clip” "PEDCATH"
         • Include in Open Cardiac if anesthesia CPT is 00560, surgical CPTs are not present, but bypass notes (MPOG Concept IDs 50399, 50409, 50410, 50416, 50417, 50714) are present, and procedure text includes: “transcatheter”, “TAVR”, “MitraClip”, “Mitra Clip”, “Mitral Clip”, “Mitral Valve Clip” "PEDCATH"
         • Exclude from Open Cardiac if anesthesia CPT is 00560, surgical CPTs are not present,  bypass notes (MPOG Concept IDs 50399, 50409, 50410, 50416, 50417, 50714) are NOT present, and procedure text includes: “transcatheter”, “TAVR”, “MitraClip”, “Mitra Clip”, “Mitral Clip”, “Mitral Valve Clip” "PEDCATH"
         • Bypass notes: 
           • 50399    Cardiopulmonary bypass -- aortic clamp on/off note
           • 50409    Cardiopulmonary bypass (full/partial/left-heart) terminated
           • 50410    Cardiopulmonary bypass initiated (full/partial/left-heart)
           • 50416    Cardiopulmonary bypass -- crossclamp and circulatory arrest time totals
           • 50417    Cardiopulmonary bypass -- Access cannula removed note
           • 50714    Cardiopulmonary bypass - Full/partial/left-heart bypass start / stop event
       • 00561 - Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, younger than 1 year of age
       • 00562 - Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, age 1 year or older, for all non-coronary bypass procedures or for re-operation for coronary bypass more than 1 month after original operation
       • 00563 - heart Surg W/ circulatory arrest
       • 00566 - cabg w/o pump
       • 00567 - Anesthesia for direct coronary artery bypass grafting; with pump oxygenator
       • 00580 - Anesthesia for heart transplant or heart/lung transplant
     • IF none of the above anesthesia CPTs are present, and at least TWO of the following notes were documented AND procedure text does NOT include “intracran” or “crani” or “liver transplant” or “hepatic transplant”
       • 50399    Cardiopulmonary bypass -- aortic clamp on/off note
       • 50409    Cardiopulmonary bypass (full/partial/left-heart) terminated
       • 50410    Cardiopulmonary bypass initiated (full/partial/left-heart)
       • 50416    Cardiopulmonary bypass -- crossclamp and circulatory arrest time totals
       • 50417    Cardiopulmonary bypass -- Access cannula removed note
       • 50714    Cardiopulmonary bypass - Full/partial/left-heart bypass start / stop event
       • Performed under the cardiac surgical service (MPOG Concept ID: 80005, 80031, 80036, 80088, 80118)
          

Step 2: Determine if the case meets EP/Cath criteria

• Exclude if:
  • Anesthesia CPT: 00500-00529 or 00540-00548 thoracic procedures for non-cardiac surgeries
  • Anesthesia CPT: 00550 sternal debridement
  • Anesthesia CPT: 00796 for liver transplant
  • Anesthesia CPT: 00868 for kidney transplant
  • Anesthesia CPT: 01990 for organ harvest
  • Procedure text contains "Port-A-Cath"
  • Surgical service is: 
    • 80003: neurosurgery
    • 80009: orthopedics
    • 80023: urology
    • 80033: pediatric neurosurgery
    • 80034: pediatric orthopedics
    • 80035: pediatric urology
    • 80017 Medical-Gastroenterology
  • Surgical CPTs include (shoe-in transcath CPTs to bump to next bin): 
    • 92986 
    • 92987
    • 92990
    • 93580-93592
    • 33340
    • 33361-33364
    • 33418-33420
    • 33477
    • 33880-33891
    • 33990-33993
• Include if:
  1. These Anesthesia CPTs are present:
     • 00530 pacemaker insertion
     • 00534 cardioverter/defib
     • 00537 cardiac electrophys
     • 01920 catheterize heart
     • If Anesthesia 01926 or 01922 CPTs are present, include if procedure text includes “Transesophageal echo” or “ECHO TEE” UNLESS procedure text includes (“endovascular” AND ("thoracic aortic” or “thoracic aorta” or “TAA”)) OR “valv” OR “TAVR” or “transcatheter aortic” or “TEVAR” or “Mitral Clip” or “MitraClip” or “Mitral Valv Clip” or "Mitra Clip” or “Tricuspid Clip” or “Tricuspid Valv Clip”
  2. If these surgical CPTs are present:

     Cardiac Surgical CPT Code	Text Description of CPT Code
     33016-33019	pericardiocentesis and pericardial drainage with insertion of indwelling catheter
     33202-33275	Pacemaker or Implantable Defibrillator Procedures
     33285-33286	Introduction or Removal of Subcutaneous Cardiac Rhythm Monitor
     33289	Implantation of Hemodynamic Monitor
     92920-92979	Therapeutic Cardiovascular Services and Procedures on the Coronary Vessels
     92950***--92985	Other Therapeutic Cardiovascular Services and Procedures
     92998	Other Therapeutic Cardiovascular Services and Procedures
     93451- 93533	Cardiac Catheterization and Associated Procedures
     93600-93662	Intracardiac Electrophysiological Procedures/Studies

     ***If CPT 92950 is present, include if another surgical CPT in this list is present or another anesthesia CPT in the EP/Cath list is present
  3. Procedure text: 
     • “PEDCATH” "PED CATH" "CATHPED" "CATH PED" - can be an ICD implantation or a transcatheter, but should be EP/Cath still
  4. If procedure text include ONLY:  “Cardioversion” “Echocardiogram” “echo” “transesophageal echo” “transesophageal echocardiogram”  or “TEE” AND was performed under one of these procedure services: 

80005 Cardiac
80088 Cardiothoracic
80118 Cardiothoracic-vascular
80016 Medical - cardiology
80031 Pediatric Cardiac Surgery
80044 Pediatric Cardiology
80036 Pediatric Cardiothoracic Surgery
80000 Surgical Service - Not specified
80014 Surgical service – other, not listed

• Do NOT include if procedure text includes “endovascular” AND (“thoracic aortic” or “thoracic aorta” or “TAA”)) or “valve” or “valv” or “TAVR” or “transcatheter aortic” or “TEVAR” or “Mitral Clip” or “MitraClip” or “Mitral Valve Clip” or Mitra Clip” or “Tricuspid Clip” or “Tricuspid Valve Clip”, "percutaneous mitral valve", “"percutaneous tricuspid valve" are also present in the text 
  1. Procedural service:
     • 80016 - medical, cardiology
     • 80044 - pediatric cardiology
        

Step 3: Determine if the case meets Transcatheter/Endovascular criteria

• Exclude if:
  • Anesthesia CPT: 00550 sternal debridement
  • Anesthesia CPT: 00796 for liver transplant
  • Anesthesia CPT: 00868 for kidney transplant
  • Anesthesia CPT: 01990 for organ harvest
  • Surgical Services:
    • 80003: neurosurgery
    • 80009: orthopedics
    • 80023: urology
    • 80033: pediatric neurosurgery
    • 80034: pediatric orthopedics
    • 80035: pediatric urology
    • 80017 Medical-Gastroenterology
• Include if: 
  1. Anesthesia CPTs 01926 or 01922 are present, AND procedure text includes (“endovascular” AND (“thoracic aortic” or “thoracic aorta” or “TAA”)) or “valv” or “TAVR” or “transcatheter aortic” or “TEVAR” or “Mitral Clip” or “MitraClip” or “Mitral Valv Clip” or Mitra Clip” or “Tricuspid Clip” or “Tricuspid Valv Clip”, "percutaneous mitral valv", “percutaneous tricuspid valv"
     • If procedure text includes "endovascular repair of abdominal aort" or "endovascular abdominal aort" or if JUST “EVAR” or “FEVAR” (not “TEVAR”) is present then move to non-cardiac
  2. Surgical CPTs are present, include

     Cardiac Surgical CPT Code	Text Description of Surgical CPT Code
     33340	Surgical Procedures on the Heart (Including Valves) and Great Vessels Continued (perc. LAA)
     33361-33364	Surgical Procedures on Cardiac Valves (Transcatheter aortic valve)
     33418-33420	Surgical Procedures on Cardiac Valves Cont. (Transcath mitral valves)
     33477	Surgical Procedures on Cardiac Valves Cont. (transcath pulmonic valve)
     33880-33891	Endovascular Repair Procedures of the Descending Thoracic Aorta
     33990-33993	Cardiac Assist Procedures (perc. Assist device)
     92986	Balloon aortic valvuloplasty CPT code and balloon aortic valvuloplasty work RVU / balloon aortic valvuloplasty
     92987	Balloon mitral valvuloplasty CPT code and balloon mitral valvuloplasty work RVU / balloon mitral valvuloplasty
     92990	Balloon pulmonary valvuloplasty CPT code and balloon pulmonary valvuloplasty work RVU / balloon mitral valvuloplasty
     93580-93592	Repair Procedures of Structural Heart Defect

      
  3. IF surgical CPTs are not present, include IF the anesthesia CPT is a cardiac case without a pump (00560) AND these procedure text items without use of bypass notes:
     • Procedure text: “transcatheter”, “TAVR”, “MitraClip”, “Mitra Clip”, “Mitral Clip”, “Mitral Valv Clip”, “Tricuspid Clip”, “Tricuspid Valv Clip”, "percutaneous mitral valv", “percutaneous tricuspid valv"
       • Without:  
         • 50399    Cardiopulmonary bypass -- aortic clamp on/off note
         • 50409    Cardiopulmonary bypass (full/partial/left-heart) terminated
         • 50410    Cardiopulmonary bypass initiated (full/partial/left-heart)
         • 50416    Cardiopulmonary bypass -- crossclamp and circulatory arrest time totals
         • 50417    Cardiopulmonary bypass -- Access cannula removed note
         • 50714    Cardiopulmonary bypass - Full/partial/left-heart bypass start / stop event

Step 4: Determine if the case meets Other Cardiac criteria

• Exclude if:
  • Anesthesia CPT: 00796 for liver transplant
  • Anesthesia CPT: 00868 for kidney transplant
  • Anesthesia CPT: 01990 for organ harvest
  • Anesthesia CPT: 00500-00540 thoracic procedures for non-cardiac surgeries
  • Anesthesia CPT: 00700-00797 for upper abdominal procedures
  • Procedure text includes only: 'emergent intubation', 'emergently intubated', ‘FLOOR/ICU INTUBATION’, ‘EMERGENT INTUBATION’, ‘emergency Intubation’, ‘intubation’, ‘INTUBATION – EMERGENT’, and ‘Intubation out of OR’.  Text searching is not case-sensitive and must be exact.
  • Procedure text includes only: "Nerve Block" or "RAAPS Nerve Block"
  • Surgical Services:
    • 80003: neurosurgery
    • 80009: orthopedics
    • 80023: urology
    • 80033: pediatric neurosurgery
    • 80034: pediatric orthopedics
    • 80035: pediatric urology
    • 80017 Medical-Gastroenterology
• Include if:
  1. Anesthesia CPT: 00550 sternal debridement
  2. If predicted CPT is 00550, include in other cardiac (overriding any primary CPT)
  3. These surgical CPTs are present:

     Cardiac Surgical CPT Code	Text description of Surgical CPT code (CPT Code Range 33016- 33999)
     33016-33019	Pericardiocentesis and pericardial drainage with insertion of indwelling catheter
     33025	Creation of pericardial window or partial resection for drainage
     35820***	Exploration for postoperative hemorrhage, thrombosis or infection
     35840***	Exploration for postoperative hemorrhage, thrombosis or infection
     33365-33369	Surgical Procedures on Cardiac Valves (transcatheter AVR via open approach with and without bypass)
     33320	Surgical Procedures on the Heart (Including Valves) and Great Vessels (suture repair w/o shunt or bypass)
     33330	Surgical Procedures on the Heart (Including Valves) and Great Vessels Continued (graft without shunt or bypass)
     33946-33959	Extracorporeal Membrane Oxygenation or Extracorporeal Life Support Services and Procedures
     33962-33974	Cardiac Assist Procedures (ECMO and IABP)
     33984-33989	Cardiac Assist Procedures (ECMO and IABP)
     33999	Other Cardiac Surgery Procedures

     *** If CPTS 35820 and 35840, they must also have another cardiac open, cardiac ep/cath, cardiac transcath/endovasc or cardiac other surgical CPT, anesthesia CPT, or have another indicator of a cardiac case as listed below:

     • 50399    Cardiopulmonary bypass -- aortic clamp on/off note
     • 50409    Cardiopulmonary bypass (full/partial/left-heart) terminated
     • 50410    Cardiopulmonary bypass initiated (full/partial/left-heart)
     • 50416    Cardiopulmonary bypass -- crossclamp and circulatory arrest time totals
     • 50417    Cardiopulmonary bypass -- Access cannula removed note
     • 50714    Cardiopulmonary bypass - Full/partial/left-heart bypass start / stop event
  4. IF the anesthesia CPT is 00560, and a cardiac surgical service was documented, AND procedure text does NOT include “intracran” or “crani” or “liver transplant” or “hepatic transplant”
     • Performed under the cardiac surgical service (MPOG Concept ID: 80005, 80031, 80036, 80088, 80118)
  5. If any of the above (for Cardiac Open, EP/Cath, or Transcath.) PREDICTED or ACTUAL Surgical or Anesthesia CPTs are present, but the cases were removed due to other exclusions, include these cases in Cardiac Other

Final Step: Determine the final category based on the hierarchy below (apply rules in this order). If a case meets criteria for more than one category, assign it to the category closest to the top of the list. If the case does not meet criteria listed in steps 1-4, will determine case to be non-cardiac.

1. Open Cardiac
2. EP/Cath
3. Transcatheter/Endovascular
4. Other Cardiac
5. Non-Cardiac