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A left heart catheterization is a specialized medical procedure performed to assess and treat congenital heart defects. This procedure involves the insertion of a catheter into the left side of the heart, which includes the left atrium and left ventricle. The process begins with the preparation of the patient, where the skin over the chosen artery—commonly the brachial, axillary, or femoral artery—is thoroughly cleansed, and a local anesthetic is administered to minimize discomfort. Following this, a needle is used to puncture the artery, and a sheath is placed to facilitate the introduction of the catheter. The proceduralist utilizes imaging guidance to navigate the catheter through the vascular system, threading a guidewire retrograde through the artery and into the aorta, ultimately reaching the left side of the heart. Once the catheter is in place, the guidewire is removed, allowing for direct access to the heart chambers. During the procedure, the aortic valve, left ventricle, mitral valve, and left atrium are carefully inspected. Additionally, pressures within the left ventricle and atrium are measured, along with pressure gradients across the aortic and mitral valves, which are critical for evaluating the heart's function. In cases of congenital heart anomalies, the connections between the heart chambers and the great vessels may differ from normal anatomy. Despite these variations, the procedure is still classified as left heart catheterization. Understanding these connections is vital for diagnosing congenital heart disease, as they determine the flow of blood through the heart. Normal connections allow blood to flow from the left-sided cardiac chambers to the aorta, while abnormal connections may redirect blood through alternative pathways. The CPT® code 93595 is specifically designated for reporting left heart catheterization performed for congenital heart defects, regardless of whether the connections are normal or abnormal.
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The left heart catheterization for congenital heart defects is indicated for various conditions and symptoms that necessitate detailed evaluation of the heart's structure and function. The following are the explicitly provided indications for this procedure:
The left heart catheterization procedure involves several critical steps to ensure accurate assessment and intervention for congenital heart defects. The following procedural steps are outlined:
After the left heart catheterization procedure, patients are typically monitored for any complications or adverse effects. The site of arterial access is observed for bleeding or hematoma formation, and appropriate compression is maintained to facilitate healing. Patients may experience some discomfort at the puncture site, which should gradually subside. Follow-up care may include instructions on activity restrictions and signs of complications to watch for, ensuring a smooth recovery process. The results of the catheterization, including any findings related to congenital heart defects, will be discussed with the patient to determine the next steps in management or treatment.
| Short Descr | L HRT CATH CHD NM/ABN NT CNJ | Medium Descr | L HRT CATH CHD IMG CATH TRGT ZON NML/ABNL NT CNJ | Long Descr | Left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone, normal or abnormal native connections | Status Code | Carriers Price the Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | 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 | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
This is a primary code that can be used with these additional add-on codes.
| 93462 | Addon Code MPFS Status: Active Code APC N ASC N1 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure) | 93463 | Addon Code MPFS Status: Active Code APC N Pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed (List separately in addition to code for primary procedure) | 93464 | Addon Code MPFS Status: Active Code APC N Physiologic exercise study (eg, bicycle or arm ergometry) including assessing hemodynamic measurements before and after (List separately in addition to code for primary procedure) | 93563 | Addon Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective coronary angiography during congenital heart catheterization (List separately in addition to code for primary procedure) | 93564 | Addon Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective opacification of aortocoronary venous or arterial bypass graft(s) (eg, aortocoronary saphenous vein, free radial artery, or free mammary artery graft) to one or more coronary arteries and in situ arterial conduits (eg, internal mammary), whether native or used for bypass to one or more coronary arteries during congenital heart catheterization, when performed (List separately in addition to code for primary procedure) | 93565 | Add-on Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective left ventricular or left atrial angiography (List separately in addition to code for primary procedure) | 93566 | Addon Code MPFS Status: Active Code APC N ASC N1 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective right ventricular or right atrial angiography (List separately in addition to code for primary procedure) | 93567 | Addon Code MPFS Status: Active Code APC N ASC N1 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for supravalvular aortography (List separately in addition to code for primary procedure) | 93568 | Addon Code MPFS Status: Active Code APC N ASC N1 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for nonselective pulmonary arterial angiography (List separately in addition to code for primary procedure) | 93569 | Add-on Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, unilateral (List separately in addition to code for primary procedure) | 93571 | Addon Code MPFS Status: Carrier Priced APC N ASC N1 CPT Assistant Article Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; initial vessel (List separately in addition to code for primary procedure) | 93573 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, bilateral (List separately in addition to code for primary procedure) | 93574 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary venous angiography of each distinct pulmonary vein during cardiac catheterization (List separately in addition to code for primary procedure) | 93575 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary angiography of major aortopulmonary collateral arteries (MAPCAs) arising off the aorta or its systemic branches, during cardiac catheterization for congenital heart defects, each distinct vessel (List separately in addition to code for primary procedure) | 93598 | Add-on Code MPFS Status: Carrier Priced APC N Cardiac output measurement(s), thermodilution or other indicator dilution method, performed during cardiac catheterization for the evaluation of congenital heart defects (List separately in addition to code for primary procedure) | 93662 | Addon Code MPFS Status: Carrier Priced APC N PUB 100 CPT Assistant Article Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure) |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2022-01-01 | Added | Code added |
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