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A combined right heart and left heart catheterization is a specialized procedure performed on patients diagnosed with congenital heart defects. This procedure involves the insertion of catheters into both the right and left sides of the heart to assess and evaluate the heart's structure and function. The process begins with the cleansing of the skin over the catheter access sites to minimize the risk of infection. For the right heart catheterization, the most common access point is the right femoral vein located in the groin area. A small incision is made to facilitate the insertion of a needle into the vein, followed by the placement of a sheath to allow for the passage of a guidewire. The guidewire is carefully threaded through the venous system, navigating through the femoral vein, external iliac vein, inferior vena cava, and into the right atrium. Once the guidewire is in place, a catheter is advanced over it into the right atrium, right ventricle, and pulmonary arteries. This allows for direct inspection of the right heart chambers, where blood pressure and oxygen levels are measured, and the tricuspid and pulmonary valves are evaluated. The procedure may also include a separately reportable angiogram of the right heart and/or pulmonary arteries to visualize any abnormalities. In addition to the right heart catheterization, a retrograde left heart catheterization is performed. This involves accessing the left side of the heart through the brachial, axillary, or femoral artery. After prepping the skin, the artery is punctured, and a sheath is placed. A guidewire is then inserted and threaded retrograde through the artery into the aorta, left ventricle, and left atrium. The catheter is positioned in the left heart, allowing for the assessment of the aortic valve, left ventricle, mitral valve, and left atrium, as well as the evaluation of any congenital anomalies present in these structures. Throughout the procedure, pressures within the left ventricle and atrium are measured, along with pressure gradients across the aortic and mitral valves. The procedure may also involve positioning the catheter in the right and left coronary arteries to assess any vascular anomalies. Upon completion of the catheterization, the catheters are withdrawn, and compression dressings are applied to the access sites. It is important to report the appropriate CPT® code based on the presence of abnormal connections, as this significantly impacts the management of congenital heart defects.
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The procedure of right and left heart catheterization for congenital heart defects is indicated for patients presenting with specific congenital cardiac anomalies. These indications include:
The procedure consists of several detailed steps to ensure accurate assessment and intervention for congenital heart defects:
After the completion of the catheterization procedure, the catheters are carefully withdrawn from the access sites. Compression dressings are applied to the puncture sites to minimize bleeding and promote healing. Patients are typically monitored for any complications, such as bleeding or infection, and their vital signs are closely observed. The recovery process may vary depending on the individual patient's condition and the complexity of the congenital heart defect addressed during the procedure. Follow-up care and further evaluations may be necessary to assess the outcomes of the catheterization and to plan any additional interventions if required.
| Short Descr | R&L HRT CATH CHD ABNL NT CNJ | Medium Descr | R&L HRT CATH CHD IMG CATH TRGT ZON ABNL NT CONNJ | Long Descr | 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 | 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) | 93584 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; anomalous or persistent superior vena cava when it exists as a second contralateral superior vena cava, with native drainage to heart (List separately in addition to code for primary procedure) | 93585 | Add On Code Resequenced Code MPFS Status: Active Code APC N 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) | 93586 | Add On Code Resequenced Code MPFS Status: Active Code APC N Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; coronary sinus (List separately in addition to code for primary procedure) | 93587 | Add On Code Resequenced Code MPFS Status: Active Code APC N Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; venovenous collaterals originating at or above the heart (eg, from innominate vein) (List separately in addition to code for primary procedure) | 93588 | Add On Code Resequenced Code MPFS Status: Active Code APC N Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; venovenous collaterals originating below the heart (eg, from the inferior vena cava) (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. | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 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. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | 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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