CPT® Code 93587

Add-On Code

1. Indications

The venography procedure described by CPT® Code 93587 is indicated for patients with congenital heart defects who may exhibit symptoms related to inadequate oxygenation due to the presence of venovenous collaterals. The following conditions and situations warrant this procedure:

• Cyanosis A clinical sign indicating insufficient oxygen in the blood, often observed in patients with congenital heart defects.
• History of Fontan Procedure Patients who have undergone this surgical intervention to connect the right atrium to the pulmonary artery may develop venovenous collaterals that require assessment.
• Assessment of Venovenous Collaterals The need to evaluate the presence and anatomy of collaterals that may be contributing to inadequate pulmonary blood flow.

2. Procedure

The procedure for CPT® Code 93587 involves several critical steps to ensure accurate assessment of venovenous collaterals. The process begins with the insertion of a guide catheter through a venous access sheath, which is then threaded over a guidewire into the heart. This initial step is crucial as it establishes access to the systemic venous pathways that drain into the heart. Once the guide catheter is in place, the next step involves directing the guidewire into all systemic venous pathways that are draining to the heart from a level at or above the heart. This is essential for identifying the specific areas where venovenous collaterals may be present. Following the positioning of the guidewire, contrast material is injected into the venous system. This contrast agent is vital for visualizing the venovenous collaterals on imaging studies. As the contrast flows through the veins, images are obtained to document the course and drainage of the collaterals that arise at or above the heart. If additional venovenous collaterals are identified during this imaging process, the same technique is repeated to ensure comprehensive assessment. The detailed imaging obtained from this procedure is instrumental in planning for potential embolization, which may be necessary to occlude the collaterals and prevent deoxygenated blood from bypassing the lungs.

3. Post-Procedure

After the venography procedure is completed, patients are typically monitored for any immediate complications related to the catheterization and contrast injection. Post-procedure care may include observation for signs of bleeding at the catheter insertion site, as well as monitoring vital signs to ensure stability. Patients may also be advised on activity restrictions to allow for proper recovery. The results of the venography will be analyzed to determine the presence and significance of any venovenous collaterals, guiding further management decisions, including the potential need for embolization procedures to address abnormal blood flow dynamics.