CPT® Code 93588

Add-On Code

1. Indications

The venography procedure described by CPT® Code 93588 is indicated for patients with congenital heart defects who may exhibit symptoms related to inadequate oxygenation due to the presence of venovenous collaterals. These indications include:

• Cyanosis A bluish discoloration of the skin and mucous membranes, indicating low oxygen levels in the blood, often seen in patients with significant congenital heart defects.
• History of Fontan Procedure Patients who have undergone a Fontan procedure, which connects the right atrium directly to the pulmonary artery, may develop venovenous collaterals as a complication of their heart defect repair.
• Assessment of Venous Pathways The need to evaluate the systemic venous pathways draining to the heart, particularly in the context of congenital heart defects, to understand the hemodynamics and potential interventions required.

2. Procedure

The procedure for CPT® Code 93588 involves several critical steps to ensure accurate assessment of venovenous collaterals. The process begins with the patient undergoing a primary diagnostic cardiac catheterization, where a guide catheter is inserted through a venous access sheath and advanced over a guidewire into the heart. Once the guide catheter is in place, the next step involves directing the guidewire into the systemic venous pathways that drain to the heart from a level at or above the heart, as indicated by CPT® Code 93587. Following this, contrast material is injected into the venous system to enhance the visibility of the blood vessels during imaging. The imaging process captures detailed pictures of the venovenous collaterals, allowing the healthcare provider to mark their course and drainage patterns. This step is crucial for identifying any additional venovenous collaterals that may be present at the heart level or above. The images obtained during this procedure provide essential information that aids in planning for potential embolization procedures, which may be necessary to occlude the collaterals and prevent deoxygenated blood from bypassing the lungs. The entire procedure is conducted under radiological supervision to ensure the accuracy and safety of the imaging process.

3. Post-Procedure

After the venography procedure coded as CPT® 93588, patients may require monitoring for any immediate complications related to the catheterization and contrast injection. It is essential to assess the patient's vital signs and ensure that there are no adverse reactions to the contrast material. Depending on the findings from the venography, further interventions may be planned, such as embolization to occlude the identified venovenous collaterals. Patients may also need follow-up imaging studies to evaluate the effectiveness of any interventions performed. Recovery time can vary based on the individual patient's condition and the complexity of the procedure, but generally, patients are advised to rest and avoid strenuous activities for a specified period following the procedure.