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Percutaneous transcatheter closure of the left atrial appendage with an implant is a minimally invasive procedure designed to reduce the risk of stroke in patients suffering from atrial fibrillation, a condition characterized by irregular heartbeats. This procedure is particularly important for individuals who are at an elevated risk for cardiac emboli, which are blood clots that can form in the heart and travel to the brain, leading to ischemic strokes. The left atrial appendage (LAA) is a small pouch located in the left atrium of the heart, and it is known to be a common source of these emboli in patients with atrial fibrillation. By closing off the LAA, the procedure aims to prevent blood clots from escaping into the bloodstream. The process involves several technical steps, including the use of fluoroscopy for imaging, transseptal puncture to access the left atrium, and the placement of a catheter to deliver the closure device. This procedure may also be referred to as percutaneous left atrial appendage transcatheter occlusion, highlighting its role in occluding the LAA to mitigate stroke risk. The access for this procedure is typically through the right femoral vein, where a small incision is made to facilitate catheter insertion. Overall, this intervention is a critical option for managing stroke risk in patients with atrial fibrillation, providing a less invasive alternative to surgical approaches.
© Copyright 2025 Coding Ahead. All rights reserved.
The percutaneous transcatheter closure of the left atrial appendage is indicated for patients with atrial fibrillation who are at increased risk for cardiac emboli and ischemic stroke. This procedure is particularly beneficial for individuals who may not be suitable candidates for long-term anticoagulation therapy due to various reasons, including a history of bleeding complications or other contraindications to anticoagulants.
The procedure begins with the patient positioned appropriately, and local anesthesia is administered at the access site, typically the right femoral vein in the groin. A small stab incision is made in the skin, and a needle is inserted into the blood vessel, followed by the placement of a sheath. A guidewire is then threaded through the femoral vein, external iliac vein, inferior vena cava, and into the right atrium. Once the catheter is positioned correctly, the guidewire is withdrawn. The heart catheter is then advanced into the left heart through the intact septum via transseptal puncture, which is performed using a standard transseptal needle and sheath. This puncture is guided by transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) to ensure accuracy in accessing the left atrial appendage. Alternatively, contrast angiography may be utilized to visualize the left atrium and measure the dimensions of the LAA. After confirming the size of the ostium, an appropriately sized occlusion device is selected. Continuous TEE and fluoroscopy are employed to guide the advancement of the compressed sheathed device into the LAA cavity. Once positioned correctly, the sheath is withdrawn, and the device is deployed and seated within the LAA. The positioning of the device is verified again using TEE and/or contrast angiography to ensure proper placement. Upon completion of the procedure, the catheters are withdrawn, and pressure is applied to the venous puncture site, followed by the application of compression dressings to promote hemostasis.
After the procedure, patients are typically monitored for any complications, such as bleeding or arrhythmias. The recovery period may vary, but patients are generally advised to rest and avoid strenuous activities for a specified duration. Follow-up appointments are essential to assess the device's position and function, as well as to monitor the patient's overall cardiovascular health. Patients may also receive instructions regarding medication management, including any anticoagulation therapy that may be necessary post-procedure, depending on their individual risk factors and physician recommendations.
| Short Descr | LAA CLOSURE W/IMPLANT | Medium Descr | PERC TRANSCTH CLOSR LT ATRIAL APPNDGE IMPLNT S&I | Long Descr | Percutaneous transcatheter closure of the left atrial appendage with implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, radiological supervision and interpretation | 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 | 9 - 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 | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T2D - Other tests - other | MUE | Not applicable/unspecified. | CCS Clinical Classification | 63 - Other non-OR therapeutic cardiovascular procedures |
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| 2016-12-31 | Deleted | Code deleted. See 33340. |
| 2012-01-01 | Added | Added |
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