© Copyright 2025 American Medical Association. All rights reserved.
Transcatheter tricuspid valve implantation (TTVI) or replacement with a prosthetic valve is a minimally invasive procedure aimed at addressing severe tricuspid valve (TV) regurgitation, a condition where the tricuspid valve does not close properly, allowing blood to flow backward into the right atrium. This procedure is performed using a percutaneous approach, which means it is done through the skin, typically via the femoral vein, rather than through open-heart surgery. Various devices have been developed for TTVI, including annuloplasty devices, leaflet/coaptation devices, and valve replacement devices, each designed to reduce the severity of regurgitation through different mechanisms. For instance, coaptation devices may work by plicating the valve leaflets or by using a spacer to occupy the valve orifice, thereby improving closure. The procedure is generally conducted under general anesthesia and requires the use of multiple imaging modalities to guide the intervention accurately. A commonly utilized TTVI device features a steerable guide catheter (SGC) and a clip delivery system (CDS), which includes a steerable sleeve and a chrome-cobalt clip with articulated arms designed to grasp and draw the valve leaflets together. The procedure may employ techniques such as the triple-orifice technique, where clips are placed between the septal and anterior tricuspid leaflets as well as between the septal and posterior leaflets, or the bicuspidization technique, which focuses on the septal and anterior leaflets. The initial steps involve approximating the leaflets with a clip, followed by the careful placement of additional clips to ensure proper alignment and closure. Throughout the procedure, anticoagulation with heparin is administered to prevent thrombus formation, and careful monitoring is conducted to verify the effectiveness of the intervention before finalizing the clip deployment and removing the delivery system.
© Copyright 2025 Coding Ahead. All rights reserved.
The transcatheter tricuspid valve implantation (TTVI) or replacement procedure is indicated for patients suffering from severe tricuspid valve (TV) regurgitation. This condition can lead to significant clinical symptoms and complications, necessitating intervention to restore proper valve function and improve hemodynamics.
The TTVI procedure involves several critical steps to ensure successful implantation or replacement of the tricuspid valve. Initially, the patient is placed under general anesthesia to ensure comfort and immobility during the procedure.
Post-procedure care involves monitoring the patient for any complications and assessing the function of the newly implanted or replaced tricuspid valve. Patients may require observation in a recovery area, and follow-up imaging may be performed to evaluate the success of the procedure. Additionally, anticoagulation therapy may be continued to prevent thromboembolic events. The expected recovery time can vary based on individual patient factors and the complexity of the procedure, but many patients can resume normal activities within a few days, depending on their overall health and any underlying conditions.
| Short Descr | TTVI/RPLCMT W/PRSTC VLV PERQ | Medium Descr | TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH | Long Descr | Transcatheter tricuspid valve implantation (TTVI)/replacement with prosthetic valve, percutaneous approach, including right heart catheterization, temporary pacemaker insertion, and selective right ventricular or right atrial angiography, 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) | 2 - Standard 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | Team Surgery (66) | 1 - Team surgeons could be paid, though... | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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). | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2022-01-01 | Added | First appearance in codebook. |
| 2022-01-01 | Note | Grammar correction |
| 2022-01-01 | Changed | Code description changed. |
| 2021-07-01 | Added | Code added. |
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