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Percutaneous balloon valvuloplasty is a minimally invasive procedure aimed at treating stenosis, which refers to the narrowing of heart valves that can impede blood flow. This procedure can be performed on various heart valves, including the mitral valve, aortic valve, and pulmonary valve. The technique involves accessing the heart through a blood vessel, typically one of the femoral arteries located in the groin. The skin over the access site is prepared, and a needle is used to puncture the artery, followed by the placement of a sheath to facilitate the introduction of instruments. Continuous imaging guidance, such as fluoroscopy, is utilized throughout the procedure to ensure accurate placement of the guidewire and catheter. The guidewire is carefully navigated through the aorta and into the heart, reaching the site of the narrowed valve. Once positioned, the catheter allows for the measurement of intracardiac and intra-arterial pressures, which are critical for assessing the severity of the stenosis. After obtaining these measurements, contrast dye is injected to visualize the valve and surrounding structures through angiography. The procedure culminates in the inflation of a balloon within the valve annulus, which dilates the valve to improve blood flow. This dilation may be repeated multiple times to achieve optimal results, and post-dilation pressures are measured to evaluate the effectiveness of the procedure.
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The percutaneous balloon valvuloplasty procedure is indicated for patients experiencing significant stenosis of the mitral valve, which can lead to symptoms such as heart failure, shortness of breath, and reduced exercise tolerance. The procedure is typically considered when the severity of the stenosis warrants intervention to alleviate these symptoms and improve the patient's quality of life.
The procedure begins with the preparation of the skin over the access artery, usually the femoral artery, followed by puncturing the artery with a needle. A sheath is then placed to facilitate the introduction of a guidewire. Using continuous imaging guidance, the guidewire is carefully advanced through the aorta and into the heart, reaching the opening of the stenosed mitral valve. Once the guidewire is in place, a catheter is advanced over the guidewire and positioned within the heart. The guidewire is subsequently withdrawn, allowing for the measurement of intracardiac and intra-arterial pressures. For mitral balloon valvuloplasty, the catheter is advanced into the left atrium and left ventricle to obtain pressure readings. After pressure measurements are recorded, contrast dye is injected, and angiography is performed to visualize the valve and assess its anatomy. The valve annulus is measured using still frames from the angiography. The initial catheter is exchanged for a wire-positioning catheter, through which a guidewire is advanced and positioned through the stenosed valve. The wire guiding catheter is then removed, and a balloon valvuloplasty catheter is advanced over the guidewire and centered in the valve annulus. The balloon is inflated to dilate the valve, and this inflation may be repeated multiple times to achieve the desired dilation. Upon completion of the dilation, intracardiac and intra-arterial pressures are measured again, and a completion angiogram is performed to evaluate the mobility of the valve and the filling of the cardiac chambers and great vessels.
After the completion of the percutaneous balloon valvuloplasty, patients are typically monitored for any complications and to assess the effectiveness of the procedure. Post-procedure care may include monitoring vital signs, managing any discomfort, and ensuring proper recovery from sedation or anesthesia. Patients may be advised on activity restrictions and follow-up appointments to evaluate the success of the procedure and the need for any further interventions. It is essential to assess the patient's response to the procedure, including improvements in symptoms and functional capacity.
| Short Descr | REVISION OF MITRAL VALVE | Medium Descr | PRQ BALLOON VALVULOPLASTY MITRAL VALVE | Long Descr | Percutaneous balloon valvuloplasty; mitral valve | Status Code | Active Code | Global Days | 090 - Major Surgery | 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) | 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 | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 43 - Heart valve procedures |
This is a primary code that can be used with these additional add-on codes.
| 93662 | Addon Code MPFS Status: Carrier Priced APC N PUB 100 CPT Assistant Article Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure) |
| 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 1996-01-01 | Added | First appearance in code book in 1996. |
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