CPT® Code 93585 | Case2Code

Official Description

Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; azygos/hemiazygos venous system (List separately in addition to code for primary procedure)

Common Language Description

This procedure, identified by CPT® Code 93585, involves performing a venography specifically for congenital heart defects, which includes the placement of a catheter and the necessary radiological supervision and interpretation. The focus of this venography is on the azygos and hemiazygos venous systems, which are critical components in the venous drainage of the thoracic cavity. This service is typically conducted as an add-on to a primary diagnostic cardiac catheterization, particularly in pediatric patients who present with congenital heart defects. A common clinical scenario for this procedure is seen in infants diagnosed with cardiac heterotaxy, a condition where the heart is positioned abnormally within the chest and is often associated with various complex anatomical anomalies. The azygos vein, which ascends along the right side of the posterior mediastinum, plays a vital role in returning deoxygenated blood from the lower body to the heart. It originates from the inferior vena cava (IVC) at a level comparable to the renal veins and ultimately drains into the superior vena cava (SVC), facilitating the return of blood to the right atrium. The hemiazygos vein serves as a tributary that collects blood from the left mediastinum and the lower left esophagus, crossing over to the right side at approximately the T9 vertebral level to join the azygos vein. During the procedure, a guide catheter is inserted through a venous access sheath and advanced over a guidewire into the inferior vena cava as part of a diagnostic right and left heart catheterization. Once positioned, contrast material is injected to visualize the venous structures, and images are captured to evaluate the anatomy and drainage patterns of the azygos and hemiazygos venous systems. If an anomalous inferior vena cava is identified, the guidewire is maneuvered into this additional vessel, and the catheter is repositioned accordingly to perform the venography, ensuring a comprehensive assessment of the venous drainage in the context of the congenital heart defect.

1. Indications

The venography procedure described by CPT® Code 93585 is indicated for specific clinical scenarios involving congenital heart defects. The following conditions may warrant the performance of this procedure:

Congenital Heart Defects: This procedure is performed in pediatric patients diagnosed with congenital heart defects, particularly when there is a need to assess the azygos or hemiazygos venous systems.
Cardiac Heterotaxy: Infants with cardiac heterotaxy, where the heart is abnormally positioned in the chest, often accompanied by complex anatomical anomalies, are typical candidates for this venography.
Assessment of Venous Drainage: The procedure is indicated when there is a need to evaluate the venous drainage patterns of the azygos and hemiazygos veins, especially in the context of congenital anomalies.

2. Procedure

The procedure for CPT® Code 93585 involves several critical steps to ensure accurate venography of the azygos and hemiazygos venous systems. The following procedural steps are undertaken:

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 inferior vena cava (IVC) as part of a diagnostic right and left heart catheterization. This initial step is crucial for gaining access to the venous system.
Step 2: Contrast Injection - Once the guide catheter is properly positioned within the IVC, contrast material is injected through the catheter. This contrast agent is essential for visualizing the venous structures during imaging, allowing for clear delineation of the azygos and hemiazygos veins.
Step 3: Imaging Acquisition - Radiological images are acquired following the injection of contrast. These images provide critical information regarding the anatomy and function of the azygos and hemiazygos venous systems, which is vital for assessing any congenital anomalies present.
Step 4: Assessment of Anomalous IVC - If a second inferior vena cava is identified during the procedure, the guidewire is threaded into this anomalous vessel. The catheter is then repositioned over the guidewire into the target area to ensure comprehensive evaluation.
Step 5: Additional Contrast Injection and Venography - After repositioning, contrast is injected again, and venography is performed to assess the drainage patterns of the azygos and hemiazygos venous systems. This step is critical for understanding the venous return in the context of the patient's congenital heart defect.

3. Post-Procedure

Post-procedure care following the venography for congenital heart defects involves monitoring the patient for any immediate complications related to the catheterization and contrast injection. Patients are typically observed for signs of bleeding, infection, or adverse reactions to the contrast material. Recovery may vary depending on the individual patient's condition and the complexity of the congenital heart defect. Follow-up imaging or assessments may be required to evaluate the outcomes of the procedure and to ensure that the venous drainage is functioning appropriately. Additionally, healthcare providers may need to discuss the findings with the patient's family and plan any further interventions or treatments based on the results of the venography.

Short Descr	VNGRPH CHD AZYGS/HEMIAZYGS
Medium Descr	VENOGRAPHY CHD AZYGOS/HEMIAZYGOS VENOUS SYSTEM
Long Descr	Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; azygos/hemiazygos venous system (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