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The procedure described by CPT® Code 0805T involves the implantation of a prosthetic valve in the superior and inferior vena cava, specifically referred to as caval valve implantation (CAVI). This intervention is primarily indicated for patients suffering from heart failure that is associated with severe tricuspid valve regurgitation. The procedure is performed using a percutaneous approach, which means that access to the femoral veins is achieved through the skin without the need for large incisions. This minimally invasive technique allows for the introduction of specialized instruments and devices necessary for the valve implantation. The use of the femoral veins, both left and right, facilitates the navigation of catheters and delivery systems to the heart's right atrium and the superior vena cava (SVC). The careful positioning and deployment of the prosthetic valve are critical to ensure proper function and to avoid complications, such as obstruction of the hepatic vein. The procedure is guided by imaging techniques, including fluoroscopy and echocardiography, to confirm the correct placement of the valve within the vascular structures. Overall, this advanced procedure aims to improve hemodynamics and alleviate symptoms associated with tricuspid valve dysfunction in patients with significant heart failure.
© Copyright 2025 Coding Ahead. All rights reserved.
The transcatheter superior and inferior vena cava prosthetic valve implantation (CPT® Code 0805T) is indicated for the following conditions:
The procedure begins with the percutaneous access of the left and right femoral veins. This is achieved by inserting introducer sheaths into the veins, which serve as pathways for the subsequent instruments. Following this, a pulmonary catheter is introduced into the left femoral vein and advanced towards the right pulmonary artery, reaching the area where the superior vena cava (SVC) crosses. An angiogram is then performed to visualize the SVC, utilizing a catheter that has been introduced through the right femoral vein. After obtaining the necessary images, the catheter is exchanged for a guidewire, which will facilitate the delivery of the prosthetic valve.
Next, a small incision is made at the access site to allow for the introduction of the valve delivery system. This system is carefully threaded over the guidewire, navigating through the inferior vena cava (IVC) and into the right atrium and SVC. The positioning of the valve is critical; the upper portion is placed at the juncture of the SVC and right atrium, while the middle portion is positioned above the crossing of the right pulmonary artery. The correct placement is confirmed using fluoroscopy and echocardiography, ensuring that the valve is optimally situated for function.
Once the positioning is verified, the upper portion of the valve is deployed first, followed by the complete unsheathing of the prosthetic valve. After deployment, the delivery system is removed over the guidewire, and the functionality of the device is tested to ensure it operates as intended. Subsequently, the catheter that was positioned at the crossing of the right pulmonary artery and SVC is withdrawn and repositioned in the suprahepatic vein. This step is crucial for the accurate placement of the IVC valve, which is then loaded onto the delivery catheter and advanced to the diaphragm, just above the hepatic vein inflow. The valve is positioned at the cavo-atrial junction, with careful mapping performed during the procedure to avoid obstructing the hepatic vein. Finally, the valve is deployed, and its position is confirmed once more before all instruments are removed from the patient.
Post-procedure care involves monitoring the patient for any immediate complications that may arise from the valve implantation. This includes assessing the patient's hemodynamic status and ensuring that there are no signs of obstruction or other adverse effects related to the newly implanted valve. Follow-up imaging may be required to confirm the proper placement and function of the valve over time. Additionally, the patient may need to be monitored for any signs of infection or bleeding at the access site. The healthcare team will provide specific instructions regarding activity restrictions and any necessary follow-up appointments to ensure optimal recovery and management of the patient's heart failure condition.
| Short Descr | TCAT S&IVC PRSTC VL IMPL PRQ | Medium Descr | TCAT SUPR&IVC PROSTC VLV IMPLTJ PERQ FEM VN APPR | Long Descr | Transcatheter superior and inferior vena cava prosthetic valve implantation (ie, caval valve implantation [CAVI]); percutaneous femoral vein approach | 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) | 0 - Payment restriction for assistants at surgery applies 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 |
| 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2024-01-01 | Added | First appearance in code book. |
| 2023-07-01 | Added | Code added. |
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