CPT® Code 0613T

Official Description

Percutaneous transcatheter implantation of interatrial septal shunt device, including right and left heart catheterization, intracardiac echocardiography, and imaging guidance by the proceduralist, when performed

Common Language Description

The CPT® Code 0613T refers to the procedure of percutaneous transcatheter implantation of an interatrial septal shunt device (IASD). This innovative medical intervention is specifically designed to address heart failure with preserved ejection fraction by effectively reducing elevated left atrial pressure while ensuring the integrity of the left ventricle is maintained. The IASD functions by creating and sustaining a patent communication between the left and right atria, which is crucial for alleviating symptoms associated with heart failure. The device itself is constructed as a single-piece, expanding metal cage featuring an open barrel measuring 8 mm in diameter at its center. It is designed with multiple legs on both sides; the left atrial side is flat to ensure it lies flush against the atrial wall, while the right atrial side is curved, allowing only the legs to make contact with the wall. The procedure typically begins with standard transseptal catheterization, which is performed through a puncture in the right femoral vein, although access via the left femoral vein may also be utilized if necessary. Under imaging guidance, a guidewire is advanced to the superior vena cava, followed by the execution of a septal puncture using established techniques. Subsequently, a delivery sheath is advanced over the guidewire into the left atrium. The shunt delivery system is then employed to deploy the IASD at the predetermined target location across the atrial septum. The device is preloaded into the distal tip of an inner catheter, and the outer catheter is carefully retracted to position the device correctly. This process involves releasing the implant legs and the barrel in a controlled manner, ensuring that the legs are first seated on the left atrial side of the opening, followed by the right side, with imaging confirmation verifying that the IASD is correctly positioned. Notably, the implant is designed to be both radiopaque and echogenic, facilitating effective imaging throughout the procedure.

1. Indications

The percutaneous transcatheter implantation of an interatrial septal shunt device (IASD) is indicated for patients experiencing heart failure with preserved ejection fraction. This procedure is specifically aimed at reducing elevated left atrial pressure, which is a common complication in such patients, while also ensuring that the left ventricular function remains intact. The IASD is utilized to create and maintain a patent septal communication between the left and right atria, thereby alleviating symptoms associated with heart failure.

Heart Failure with Preserved Ejection Fraction This condition is characterized by the heart's inability to pump blood effectively despite normal ejection fraction, leading to elevated pressures in the left atrium.

2. Procedure

The procedure for the implantation of the interatrial septal shunt device involves several critical steps that ensure successful placement and functionality of the device.

Step 1: Accessing the Femoral Vein The procedure begins with the standard transseptal catheterization technique, which typically involves puncturing the right femoral vein. In certain cases, access may also be obtained through the left femoral vein, depending on the patient's anatomy and clinical considerations.
Step 2: Advancing the Guidewire Once access is secured, a guidewire is advanced under imaging guidance to the superior vena cava. This step is crucial as it sets the pathway for subsequent catheterization.
Step 3: Performing the Septal Puncture Following the guidewire placement, a septal puncture is performed using standard techniques. This allows for the introduction of the delivery sheath into the left atrium.
Step 4: Advancing the Delivery Sheath The delivery sheath is then advanced over the guidewire into the left atrium, positioning it for the deployment of the IASD.
Step 5: Deploying the IASD The shunt delivery system is utilized to deploy the IASD at the target location across the atrial septum. The device is preloaded into the distal tip of the inner catheter, ensuring it is ready for placement.
Step 6: Seating the Device The outer catheter is carefully retracted to seat the device in place. This process involves releasing the implant legs and the barrel in a controlled manner, ensuring that the legs are first seated on the left atrial side of the opening, followed by the right side.
Step 7: Confirming Positioning Imaging confirmation is performed to verify that the IASD is correctly positioned within the atrial septum, ensuring optimal functionality of the device.

3. Post-Procedure

After the implantation of the interatrial septal shunt device, patients are typically monitored for any immediate complications or adverse effects. Post-procedure care may include observation for signs of bleeding at the access site, arrhythmias, or other procedural complications. Patients may also undergo imaging studies to confirm the proper placement of the device and assess its functionality. Recovery protocols will vary based on individual patient factors and institutional guidelines, but generally, patients can expect to resume normal activities within a specified recovery period as advised by their healthcare provider.

Short Descr	PERQ TCAT INTRATRL SEPTL SHT
Medium Descr	PERQ TCAT IMPLTJ INTRATRL SEPTAL SHUNT DEVICE
Long Descr	Percutaneous transcatheter implantation of interatrial septal shunt device, including right and left heart catheterization, intracardiac echocardiography, and imaging guidance by the proceduralist, when performed
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)	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	Non-Covered Service, not paid under OPPS
Berenson-Eggers TOS (BETOS)	none
MUE	1

82	Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
GC	This service has been performed in part by a resident under the direction of a teaching physician
Q0	Investigational clinical service provided in a clinical research study that is in an approved clinical research study