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The procedure described by CPT® Code 0258T involves the replacement of a stenotic aortic heart valve with a prosthetic valve, utilizing a catheter-based approach through transthoracic cardiac exposure. This exposure can be achieved via several surgical techniques, including sternotomy, thoracotomy, or subxiphoid incision. During the procedure, the pericardium, which is the fibrous sac surrounding the heart, is incised to allow access to the heart. Notably, this specific code pertains to cases where the procedure is performed without the use of cardiopulmonary bypass, which is a technique that temporarily takes over the function of the heart and lungs during surgery. In such cases, epicardial pacing wires are placed on the left ventricle to facilitate pacing of the heart while the valve is being delivered. This method is crucial for ensuring that the heart maintains an appropriate rhythm during the procedure, particularly when bypass is not utilized. The overall goal of this intervention is to effectively replace the dysfunctional aortic valve, thereby improving blood flow and alleviating symptoms associated with aortic stenosis.
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The procedure described by CPT® Code 0258T is indicated for patients with aortic stenosis, which is characterized by the narrowing of the aortic valve opening, leading to obstructed blood flow from the heart to the aorta and subsequently to the rest of the body. This condition can result in symptoms such as shortness of breath, chest pain, fatigue, and syncope. The procedure is performed when these symptoms become severe and significantly impact the patient's quality of life, and when the patient is deemed suitable for a catheter-delivered approach to valve replacement.
The procedure begins with the selection of the appropriate transthoracic approach, which may include sternotomy, thoracotomy, or subxiphoid incision, to gain access to the heart. Once the surgical site is prepared, the pericardium is incised to expose the heart. In cases where cardiopulmonary bypass is not utilized, epicardial pacing wires are placed on the left ventricle to ensure the heart can be paced during the valve delivery process. The next step involves the insertion of a catheter that will deliver the prosthetic aortic valve. If necessary, the native aortic valve may be dilated using a balloon catheter to facilitate the placement of the new valve. The prosthetic valve is then positioned within the native aortic valve and deployed. A balloon catheter is utilized to properly seat the valve in place. Following deployment, contrast is injected, and angiograms are obtained to verify the position and function of the newly placed prosthetic valve. If the procedure was performed without cardiopulmonary bypass, the surgical team will monitor the heart's rhythm and function closely. After confirming the successful placement of the valve, any necessary chest tubes are placed, and the chest incision is closed to complete the procedure.
Post-procedure care involves monitoring the patient for any complications that may arise following the valve replacement. This includes assessing the heart's rhythm and function, particularly if epicardial pacing wires were used. Patients may require additional imaging studies to ensure the proper function of the prosthetic valve. Chest tubes, if placed, will be monitored for drainage and removed as appropriate. The surgical site will be assessed for signs of infection or other complications. Recovery will vary based on the individual patient's condition and the specifics of the procedure performed, but close follow-up is essential to ensure optimal outcomes.
| Short Descr | AORTIC HRT VALV W/O CARD BYP | Medium Descr | TTHRC EXPOS CATH-DELIV AORTIC VALVE W/O CARD BYP | Long Descr | Transthoracic cardiac exposure (eg, sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; without cardiopulmonary bypass | Status Code | Carriers Price the Code | Global Days | YYY - Carrier Determines Whether Global Concept Applies | 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) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 1 - Team surgeons could be paid, though... | 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 | 43 - Heart valve procedures |
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