CPT® Code 93584 | Case2Code

Official Description

Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; anomalous or persistent superior vena cava when it exists as a second contralateral superior vena cava, with native drainage to heart (List separately in addition to code for primary procedure)

Common Language Description

This procedure, identified by CPT® Code 93584, involves venography specifically for congenital heart defects, focusing on the assessment of an anomalous or persistent superior vena cava (SVC). The SVC is a significant vein responsible for returning deoxygenated blood from the upper body to the heart, particularly the right atrium. In pediatric patients with congenital heart defects, the presence of an anomalous SVC can complicate the management and surgical planning of their condition. The most prevalent anomaly is a persistent left-sided SVC, which arises from the left subclavian and internal jugular veins and drains into the right atrium via the coronary sinus. This anatomical variation is observed in approximately 10% of individuals with congenital heart disease. The procedure is typically performed in conjunction with a primary diagnostic cardiac catheterization, particularly in cases such as hypoplastic left heart syndrome, where understanding the vascular anatomy is crucial for planning subsequent surgical interventions, such as cavopulmonary anastomosis. During the venography, a guide catheter is inserted through a venous access sheath and advanced over a guidewire into the superior vena cava. Contrast material is then injected to visualize the anatomy, and images are captured to delineate the course of the anomalous vessel. This detailed imaging is essential for clinicians to accurately assess the vascular structure and make informed decisions regarding further treatment options.

1. Indications

The venography procedure described by CPT® Code 93584 is indicated for specific conditions related to congenital heart defects, particularly when assessing the anatomy of an anomalous or persistent superior vena cava. The following indications are explicitly recognized for this procedure:

Congenital Heart Defects Assessment of patients with congenital heart defects requiring detailed vascular imaging to plan surgical interventions.
Anomalous Superior Vena Cava Evaluation of patients with an anomalous or persistent left-sided superior vena cava, which may complicate the management of their congenital heart condition.
Hypoplastic Left Heart Syndrome Patients with hypoplastic left heart syndrome who may have an anomalous SVC and require venography to assist in surgical planning.

2. Procedure

The procedure for CPT® Code 93584 involves several critical steps to ensure accurate imaging of the anomalous superior vena cava. The following procedural steps are outlined:

Step 1: Catheter Placement A guide catheter is inserted through a venous access sheath, which is typically placed in a peripheral vein. The catheter is then advanced over a guidewire into the superior vena cava during a primary diagnostic cardiac catheterization. This initial placement is crucial for accessing the vascular system and preparing for the venography.
Step 2: Contrast Injection Once the guide catheter is properly positioned, contrast material is injected into the superior vena cava. This contrast enhances the visibility of the vascular structures during imaging, allowing for a clearer assessment of the anatomy.
Step 3: Imaging Acquisition Radiological images are acquired following the contrast injection. These images are essential for visualizing the course of the superior vena cava and identifying any anomalies present.
Step 4: Accessing the Anomalous SVC The catheter is then threaded over the guidewire into the second, persistent left-sided superior vena cava. This step is critical for obtaining additional images of the anomalous vessel.
Step 5: Additional Contrast Injection A second injection of contrast is performed to visualize the anomalous SVC. This additional imaging is necessary to map out the course of the vessel accurately.

3. Post-Procedure

After the venography procedure is completed, patients may require monitoring for any potential complications associated with catheterization and contrast use. It is essential to assess the access site for bleeding or hematoma formation. Patients may also be observed for any adverse reactions to the contrast material. The imaging results will be interpreted by a radiologist or cardiologist, and the findings will be used to inform further management and surgical planning for the patient's congenital heart defect. Follow-up care may include additional imaging or consultations with surgical teams, depending on the complexity of the patient's condition.

Short Descr	VNGRPH CHD ANOM/PERSIST SVC
Medium Descr	VENOGRAPHY CHD ANOMALOUS/PERSISTENT SVC NT DRG
Long Descr	Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; anomalous or persistent superior vena cava when it exists as a second contralateral superior vena cava, with native drainage to heart (List separately in addition to code for primary procedure)
Status Code	Active Code
Global Days	ZZZ - Code Related to Another Service
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	Items and Services Packaged into APC Rates
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	1

This is an add-on code that must be used in conjunction with one of these primary codes.

93593	MPFS Status: Carrier Priced APC J1 Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; normal native connections
93594	MPFS Status: Carrier Priced APC J1 Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; abnormal native connections
93596	MPFS Status: Carrier Priced APC J1 Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone(s); normal native connections
93597	MPFS Status: Carrier Priced APC J1 Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone(s); abnormal native connections