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The procedure described by CPT® Code 0259T involves a transthoracic cardiac exposure for the replacement of a stenotic aortic heart valve with a prosthetic valve. This replacement is achieved through a catheter-delivered method, which allows for less invasive access to the heart compared to traditional surgical techniques. The term "transthoracic" refers to the approach taken to access the heart, which can be through a sternotomy (opening the chest through the breastbone), thoracotomy (opening the chest through the side), or subxiphoid (accessing the heart from below the xiphoid process). During this procedure, the pericardium, the protective sac surrounding the heart, is incised to allow for direct access. If the procedure is performed without the use of cardiopulmonary bypass, which is indicated by CPT® Code 0258T, epicardial pacing wires are placed on the left ventricle to facilitate pacing of the heart during the valve delivery. However, when cardiopulmonary bypass is utilized, as indicated by CPT® Code 0259T, specific cannulation techniques are employed. A venous cannula is inserted into the right atrial appendage, and an arterial cannula is placed in the ascending aorta to manage blood flow during the procedure. Additionally, a cardioplegia cannula is introduced into the coronary sinus through a stab incision in the right atrium, and another cannula is positioned in the ascending aorta to deliver cardioplegic solution, which temporarily stops the heart to allow for a safe surgical environment. A left ventricular vent is also placed in the right superior pulmonary vein to assist in managing the heart's function during the procedure. Once cardiopulmonary bypass is established and cardioplegic arrest is initiated, a small incision is made in the aorta or left ventricle to facilitate the introduction of the catheter and the collapsed prosthetic aortic valve. The native aortic valve may be dilated using a balloon catheter to ensure proper placement of the prosthetic valve. The prosthetic valve is then positioned within the native valve and deployed, followed by the use of a balloon catheter to secure its placement. To confirm the correct positioning and functionality of the prosthetic valve, contrast is injected, and angiograms are obtained. After the procedure, if cardiopulmonary bypass was used, the aortic cross clamp is removed, and the patient is gradually weaned off bypass. Finally, chest tubes may be placed as necessary, and the chest incision is closed to complete the procedure.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 0259T is indicated for patients with a stenotic aortic heart valve, which is a condition characterized by the narrowing of the aortic valve opening, leading to obstructed blood flow from the heart to the aorta. This condition can result in symptoms such as shortness of breath, chest pain, fatigue, and syncope. The procedure is performed to replace the dysfunctional native valve with a prosthetic valve, thereby restoring normal blood flow and improving the patient's overall cardiac function.
The procedure for CPT® Code 0259T involves several critical steps to ensure the successful replacement of the aortic valve. First, the surgical team prepares the patient and administers anesthesia. The transthoracic approach is selected, which may involve a sternotomy, thoracotomy, or subxiphoid incision to access the heart. Once the chest is opened, the pericardium is incised to expose the heart. If cardiopulmonary bypass is indicated, a venous cannula is inserted into the right atrial appendage to drain venous blood, while an arterial cannula is placed in the ascending aorta to provide oxygenated blood back to the body. Next, a cardioplegia cannula is introduced into the coronary sinus through a stab incision in the right atrium, allowing for the delivery of cardioplegic solution to induce cardiac arrest and protect the heart muscle during the procedure. A second cannula is also placed in the ascending aorta to facilitate this process. A left ventricular vent is positioned in the right superior pulmonary vein to assist in managing the heart's function during the procedure. Once cardiopulmonary bypass is established and cardioplegic arrest is initiated, a small incision is made in the aorta or left ventricle to accommodate the catheter and the collapsed prosthetic aortic valve. The native aortic valve may be dilated using a balloon catheter to ensure adequate space for the prosthetic valve. The prosthetic aortic valve is then carefully positioned within the native valve and deployed. A balloon catheter is utilized to seat the valve securely in place. To verify the correct positioning and functionality of the prosthetic valve, contrast is injected, and angiograms are obtained. If the patient has been placed on cardiopulmonary bypass, the aortic cross clamp is subsequently removed, and the patient is weaned off bypass. Finally, chest tubes are placed as needed to facilitate drainage, and the chest incision is closed to complete the procedure.
Post-procedure care following the transthoracic cardiac exposure for catheter-delivered aortic valve replacement involves careful monitoring of the patient as they recover from anesthesia and the effects of cardiopulmonary bypass. Patients are typically observed in a recovery area or intensive care unit for close monitoring of vital signs, cardiac function, and any potential complications. Chest tubes, if placed, are monitored for drainage and may be removed once output decreases to acceptable levels. Patients may require pain management and support for respiratory function, including incentive spirometry to promote lung expansion. The healthcare team will assess the patient's overall recovery, including the ability to resume normal activities and any rehabilitation needs. Follow-up appointments are scheduled to evaluate the function of the prosthetic valve and the patient's overall cardiovascular health. Any signs of complications, such as infection, bleeding, or valve dysfunction, will be addressed promptly to ensure optimal recovery.
| Short Descr | AORTIC HRT VALVE W/CARD BYP | Medium Descr | CARDIAC EXPOSURE FOR AORTIC VALVE W/CARD BYPASS | Long Descr | Transthoracic cardiac exposure (eg, sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; with 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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