CPT® Code 0166T | Case2Code

Code Deleted. See 33999

Official Description

Transmyocardial transcatheter closure of ventricular septal defect, with implant; without cardiopulmonary bypass

Common Language Description

The procedure described by CPT® Code 0166T refers to the transmyocardial transcatheter closure of a ventricular septal defect (VSD) using an implant, specifically performed without the use of cardiopulmonary bypass. A ventricular septal defect is a congenital heart defect characterized by an abnormal opening in the ventricular septum, which separates the heart's left and right ventricles. This defect can lead to significant complications, including heart failure and pulmonary hypertension, due to the shunting of blood between the two chambers. The transcatheter approach allows for a minimally invasive repair of the VSD, which is particularly beneficial in patients who may not tolerate traditional open-heart surgery. During this procedure, a specialized device known as the Amplatzer septal occluder is utilized. This device is designed to effectively close the defect by deploying two discs on either side of the septal wall, thus preventing the abnormal flow of blood. The procedure involves accessing the heart through the femoral artery and vein, as well as the internal jugular vein, allowing for the precise placement of the occluder. The use of imaging techniques, such as fluoroscopy, aids in the accurate positioning of the device. Overall, this innovative technique represents a significant advancement in the treatment of VSDs, providing a less invasive option for patients while ensuring effective closure of the defect.

1. Indications

The transmyocardial transcatheter closure of a ventricular septal defect (VSD) with implant is indicated for the following conditions:

Congenital Defects Repair of congenital ventricular septal defects that may lead to hemodynamic instability or other complications.
Acute Ventricular Septal Rupture Management of acute ventricular septal rupture following a myocardial infarction, which can result in significant shunting and heart failure.

2. Procedure

The procedure for transmyocardial transcatheter closure of a VSD involves several critical steps to ensure successful implantation of the occluder device:

Accessing the Vascular System The procedure begins with the cannulation of the right femoral artery and vein, as well as the right internal jugular vein. This access is essential for navigating the vascular system to reach the heart.
Crossing the VSD A wire is advanced into the left pulmonary artery using a retrograde arterial approach. A catheter is then threaded over this wire, which is exchanged for a longer guidewire. The guidewire is snared in the pulmonary artery and extruded through the right internal jugular vein, creating an arteriovenous guidewire loop.
Measuring the Septal Defect The diameter of the septal defect is measured by passing a pre-calibrated balloon catheter filled with dilute contrast into the ventricle over the guidewire via the internal jugular access. The balloon is inflated to determine the volume necessary for occlusion of the septal defect.
Loading the Implant Device The Amplatzer septal occluder device is then loaded onto a delivery catheter, which is introduced into the ventricle. The distal disc of the device is extruded and pulled back against the distal side of the septum.
Deploying the Device After confirming proper alignment with the septal defect, the proximal disc of the occluder is deployed on the opposite side of the ventricular septum and released, effectively closing the defect.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications, such as bleeding or arrhythmias, and ensuring the proper positioning of the occluder device. Patients may require follow-up imaging studies to confirm the successful closure of the VSD and to assess the heart's function. Recovery typically involves a short hospital stay, with gradual resumption of normal activities as advised by the healthcare provider. It is essential to provide patients with instructions regarding activity restrictions and signs of potential complications that should prompt immediate medical attention.

Short Descr	TCATH VSD CLOSE W/O BYPASS
Medium Descr	TRANSMYOCARDIAL CLOSURE V-SEPTL DFCT W/O BYPASS
Long Descr	Transmyocardial transcatheter closure of ventricular septal defect, with implant; without cardiopulmonary bypass
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Discontinued Code
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.
CCS Clinical Classification	49 - Other OR heart procedures