CPT® Code 93598

Add-On Code

1. Indications

The cardiac output measurement(s) using CPT® Code 93598 is indicated for the evaluation of congenital heart defects. This procedure is performed to assess various conditions and symptoms associated with congenital anomalies of the heart, including:

• Intracardiac Shunts - Abnormal connections between the heart chambers that can lead to inefficient blood flow and oxygenation.
• Valvular Regurgitation - A condition where the heart valves do not close properly, causing blood to flow backward and affecting overall cardiac efficiency.

2. Procedure

The procedure for cardiac output measurement(s) using CPT® Code 93598 involves several detailed steps, which may vary depending on the method used for indicator dilution. The following outlines the procedural steps:

• Dye Dilution Method - In this method, venous and arterial catheters are inserted into the patient. A blood sample is first obtained, and the densitometer is calibrated using known concentrations of the dye mixed with the patient's blood sample. Once calibrated, the dye is injected into the catheterized vein. As the dye mixes with the blood, it circulates through the heart and is pumped into the arteries. A subsequent blood sample is then taken from the catheterized artery, and the densitometer analyzes this sample to measure the amount of dye present. The cardiac output is calculated based on the dye concentration in the sample.
• Cold Thermal Dilution Method - For this technique, a Swan-Ganz catheter is inserted through the internal jugular or subclavian vein into the right atrium and ventricle, with the tip advanced into a branch of the pulmonary artery. Cold dextrose is injected via the port of the Swan-Ganz catheter located in the right atrium. The cold dextrose mixes with the blood in the right atrium and ventricle, then passes into the pulmonary artery. A thermistor at the tip of the catheter detects the fall in temperature, and cardiac output is calculated using a temperature-time curve derived from this data.
• Warm Thermal Dilution Method - Similar to the cold method, a Swan-Ganz catheter with a heating coil is introduced into the right heart. A series of heat pulses are administered, and the resulting temperature changes are analyzed to calculate cardiac output. This method also provides valuable information regarding the heart's performance during the catheterization procedure.

3. Post-Procedure

After the cardiac output measurement(s) are completed, patients may require monitoring for any potential complications associated with cardiac catheterization. This includes observing for signs of bleeding, infection, or adverse reactions to the dye or thermal agents used during the procedure. The recovery process may vary depending on the patient's overall health and the complexity of the congenital heart defect being evaluated. Follow-up assessments may be necessary to interpret the results of the cardiac output measurements and to determine the appropriate management or treatment plan moving forward.