Are Aortic Valve Re-replacements covered by Medicare?

May 16, 2016 1:39 PM

My father (60 years old) was recently diagnosed with aortic stenosis due to a bicuspid valve. He will meet with a cardiologist to determine whether to get a biological replacement or mechanical - there are pros and cons to both. I have a question about Medicare coverage for the re-operation possiblity that may occur with the biological valve.

My father is an eminently practical and frugal dude. He mentioned that he likes the biological valve because he won't have to take warfarin every day, but he's worried that if he has to get the re-replacement for the biological valve, he will be 70-75 at the time and probably on Medicare. He's worried that this second replacement operation would be something not covered by Medicare. My google-fu is failing me on whether re-reoperation to replace a biological valve is something currently covered - leaving aside the complication that coverage for things may change in 10-15 years. I keep finding stories about the TAVR treatment, which I don't think applies for people who have already had a valve replaced. One article I saw said that 45% of people who get the biological valve live long enough to get it replaced, so I know this is happening, but not how it is covered insurance-wise.

Any anecdotal evidence on friends/relations, or someone who can find something about Medicare's coverage for this procedure?

posted by permiechickie to Health & Fitness (5 answers total)

Response by poster: And to clarify, he is going to listen to the recommendation of the cardiologist, but I just want to know the logistics of this in case it's a factor to my father that the cardiologist can't make a recommendation about.
posted by permiechickie at 1:41 PM on May 16, 2016

Medicare does cover aortic valve re-operations, providing a small additional fee to the surgeon to compensate for the added difficulty of the repeat procedure.

This page document what Medicare pays for various cardiac operations. Code 33530 on page 2 indicates the bonus paid for repeat valve procedures and CABGs: $549.

Best of luck to your father!
posted by reren at 2:15 PM on May 16, 2016 [1 favorite]

Oh, and TAVR can be used to replace worn out bio-prosthetic valves, though it is not yet approved in the U.S. The technique is commonly referred to as "valve-in-valve" TAVR. You can learn more here.
posted by reren at 2:37 PM on May 16, 2016 [1 favorite]

My dad had an aortic valve replacement in 1991, a loooong time ago, and he has a mechanical St Jude which requires anticoagulation with warfarin. True, he hasn't had to have a replacement valve, but on the other hand he had several small strokes because of the need to go off his warfarin in order to have other medical procedures in later years. He developed bladder cancer and needed periodic minor surgery, but needed to go off warfarin to have them. Transitioning off warfarin and onto either Lovenox or heparin, necessary because surgery is not possible when anticoagulated, opens a window where clots can, and did form. He had his hip replaced last July because he wanted to travel to Europe again and not have hip pain, but he had a substantial stroke during surgery and another one the next day. It takes several days for warfarin to wear off so surgery can occur, and several more after surgery to get back up to your anticoagulation goal, and there is a very real risk of stroke during that period. My dad has had a long road back after the recent strokes, with many months of aphasia and physical disability. He has finally largely recovered with month after month of rehab in a hospital, rehab at home, and then out-patient rehab, but he still suffers some lack of mental acuity, uses a cane, and is not able to drive. He was otherwise healthy and completely independent, but no longer. I'm not sure he could ever go independently to Europe again.

My point is that the risks to anticoagulation are real (falls, car accident, bike accident - all can result in severe bleeding) but the risks to going off warfarin temporarily are also fraught with risk. If he had to do it over again he would have chosen a tissue valve, even if it required replacement down the road. I'm not sure how much patients think about this - I know my dad was blase about it, but it is something your dad should seriously take into account.
posted by citygirl at 3:57 PM on May 16, 2016 [1 favorite]

Response by poster: citygirl - thanks for sharing your dad's story. I would prefer my father to get a biological valve because I think it back-loads the risk to a later timescale when we might have better surgery and replacement treatments. Although it's unfortunate your dad is having health problems now, surviving for 25 years and counting is great... it has been very sobering to think that my dad would basically be lucky to get another 15.
< /threadsit>
posted by permiechickie at 4:39 PM on May 16, 2016