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A paravalvular leak (PVL) refers to an abnormal connection that occurs around a prosthetic heart valve, specifically the mitral or aortic valve, where blood can flow back into the heart chamber instead of moving forward through the valve. This condition arises when the seal between the prosthetic valve and the surrounding native tissue fails to form properly, leading to potential complications such as endocarditis, hemolytic anemia, and heart failure. The procedure described by CPT® Code 93592 involves the percutaneous transcatheter closure of these leaks using occlusion devices. This minimally invasive technique is performed by inserting a vascular catheter through the femoral artery, which is then navigated to the heart. Depending on the approach—antegrade or retrograde—the catheter is maneuvered to the appropriate heart chamber to access the leak. The deployment of occlusion devices is critical, especially for larger defects that may require multiple devices to ensure complete closure. The use of this code indicates that additional occlusion devices are being utilized in conjunction with a primary procedure, highlighting the complexity and necessity of addressing multiple leaks during a single intervention.
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The procedure for percutaneous transcatheter closure of paravalvular leaks (PVL) is indicated for patients who exhibit the following conditions:
The procedure for closing a paravalvular leak involves several critical steps, which are detailed as follows:
Post-procedure care involves monitoring the patient for any complications that may arise following the closure of the paravalvular leak. Patients are typically observed for signs of bleeding, infection, or any adverse reactions to the occlusion devices. Follow-up imaging may be required to assess the effectiveness of the closure and ensure that the leak has been adequately addressed. The recovery process may vary depending on the individual patient's condition and the complexity of the procedure performed.
| Short Descr | PERQ TRANSCATH CLOSURE EACH | Medium Descr | PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV | Long Descr | Percutaneous transcatheter closure of paravalvular leak; each additional occlusion device (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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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) | P2F - Major procedure, cardiovascular-Other | MUE | 2 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2017-01-01 | Added | Added |
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