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The CPT® Code 93533 refers to a specialized procedure known as combined right heart catheterization and transseptal left heart catheterization. This procedure is performed through an existing septal opening and may include retrograde left heart catheterization, specifically for the evaluation of congenital cardiac anomalies. In simpler terms, this procedure allows healthcare professionals to access both the right and left sides of the heart to assess and diagnose any structural or functional abnormalities that may be present due to congenital heart defects. The right heart catheterization typically begins with access through the right femoral vein located in the groin area. A small incision is made to insert a needle into the vein, followed by the placement of a sheath. A guidewire is then navigated through the venous system into the right atrium, allowing for the insertion of a catheter. This catheter is advanced through the right heart chambers and into the pulmonary arteries, where various measurements, such as pressures and oxygen levels, are taken. The procedure also involves inspecting the tricuspid and pulmonary valves and may include obtaining angiograms of the right heart and pulmonary arteries. Following this, the catheter is advanced through the existing septal opening into the left heart, where the left atrium, mitral valve, left ventricle, and aortic valve are evaluated for any congenital anomalies. Pressures within the left heart chambers are measured, and additional angiograms may be performed if necessary. If retrograde left heart catheterization is indicated, a second catheter is introduced through an artery, allowing for further evaluation of the left heart structures and any associated anomalies.
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The combined right heart catheterization and transseptal left heart catheterization procedure is indicated for the evaluation of congenital cardiac anomalies. This includes conditions that may affect the structure and function of the heart, necessitating detailed assessment and diagnosis through direct visualization and measurement of pressures within the heart chambers.
The procedure begins with the right heart catheterization, which typically involves accessing the right femoral vein in the groin. A small stab incision is made to insert a needle into the vein, 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 guidewire is in place, a catheter is inserted and advanced over the guidewire into the right atrium, right ventricle, and pulmonary arteries. During this phase, the right heart chambers are inspected, and measurements of pressure and oxygen levels are obtained. The tricuspid and pulmonary valves are also evaluated, and pressure gradients across these valves are recorded. If necessary, a separately reportable angiogram of the right heart and/or pulmonary arteries may be performed to visualize any abnormalities. After completing the right heart assessment, the catheter is advanced through the existing septal opening into the left heart. In this phase, the left atrium, mitral valve, left ventricle, and aortic valve are inspected for congenital anomalies. Pressures within the left atrium and left ventricle are measured, and pressure gradients across the aortic and mitral valves are obtained. Additionally, the right and left coronary arteries may be evaluated for any anomalies, with the possibility of obtaining separately reportable angiograms as needed. If retrograde left heart catheterization is indicated, a second catheter is introduced through the brachial, axillary, or femoral artery. This catheter is threaded over a guidewire that has been placed retrograde through the artery, into the aorta, and into the left side of the heart. The left heart structures are then inspected, any cardiac anomalies are evaluated, and additional pressures are obtained to complete the assessment.
Post-procedure care typically involves monitoring the patient for any complications related to the catheterization, such as bleeding or infection at the access site. Patients may be observed for changes in vital signs and overall stability. Depending on the findings from the catheterization, further interventions or treatments may be planned. Recovery time can vary based on the individual patient's condition and the complexity of the procedure performed. Follow-up appointments may be necessary to discuss the results of the catheterization and any subsequent management strategies.
| Short Descr | R & L HEART CATH CONGENITAL | Medium Descr | CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN | Long Descr | Combined right heart catheterization and transseptal left heart catheterization through existing septal opening, with or without retrograde left heart catheterization, for congenital cardiac anomalies | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | 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 | Not applicable/unspecified. | CCS Clinical Classification | 47 - Diagnostic cardiac catheterization, coronary arteriography |
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