2025 CPT code 93597
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Cardiovascular Procedure - Cardiac Catheterization for Congenital Heart Defects Medicine/Cardiovascular/Cardiac Catheterization for Congenital Heart Defects Feed
Right and left heart catheterization for congenital heart defects with abnormal native connections, including imaging guidance.
Modifiers may be applicable depending on the circumstances.Consult the CPT manual for modifier guidelines and your payer's specific rules.
The medical necessity for this procedure is established by the presence of a congenital heart defect with abnormal native connections requiring hemodynamic evaluation and anatomical assessment to inform management decisions, guide surgical planning or assess the success of previous intervention. Documentation supporting the clinical indication and the expected benefit is required for reimbursement.
A cardiologist or other qualified healthcare professional performs this procedure.Responsibilities include pre-procedure assessment, catheter insertion and placement, hemodynamic measurements, imaging guidance and interpretation, and post-procedure care. Anesthesia and procedural support may be provided by other members of the care team.
- Medicine/Cardiovascular/Cardiac Catheterization for Congenital Heart Defects
- Medicine/Cardiovascular/Cardiac Catheterization for Congenital Heart Defects
In simple words: This procedure uses thin tubes (catheters) inserted into blood vessels to check the heart's function in children born with abnormal heart structures. The catheters are guided to the right and left sides of the heart using imaging, and blood samples are taken. This specific code applies when the heart's blood flow isn't normal due to birth defects.
This CPT code, 93597, represents the combined right and left heart catheterization procedure performed on patients with congenital heart defects exhibiting abnormal native connections.The procedure involves catheter placement in one or more right-sided cardiac chambers (right atrium, right ventricle, pulmonary artery, pulmonary wedge) and one or more left-sided chambers (left atrium, left ventricle).It includes obtaining blood samples for blood gas measurements and cardiac output measurements (Fick or other method) when performed.Imaging guidance (fluoroscopy or ultrasound) is used to guide catheter placement.The procedure also includes the interpretation and report of the imaging and hemodynamic data.In cases of congenital heart disease resulting in atypical anatomy (e.g., morphologic left ventricle in a subpulmonic position, or morphologic right ventricle in a subaortic position), catheter placement in these structures is considered part of the right or left heart catheterization respectively.Transapical or transseptal punctures, if performed, are separately reported with code 93462.Right ventricular or right atrial angiography, if performed, is separately reported with 93566; left ventricular or left atrial angiography is separately reported with 93565.Other angiography procedures may be reported separately using additional codes as per guidelines. Add-on code 93598 may be used to separately report thermodilution cardiac output measurements when performed.
Example 1: A newborn with transposition of the great arteries undergoes combined right and left heart catheterization to assess the anatomical details and pressures of the abnormal connections, guiding surgical planning.This would require code 93597 since the native connections are significantly altered., A child with tetralogy of Fallot has undergone a previous palliative surgical shunt.Combined right and left heart catheterization is performed for evaluation of the shunt, the anatomy, and the pressure gradients.Code 93597 would be used given the presence of abnormal native connections. , An infant with hypoplastic left heart syndrome undergoes staged palliation.Post-operative catheterization shows abnormal connections requiring the use of code 93597.In this instance, the procedure would be performed to assess the effectiveness of the previous surgery, assess the pressures and saturation in the abnormal connections, and evaluate potential for further procedures.
Complete medical history including congenital heart defect details, prior interventions, relevant imaging studies (echocardiograms, CT scans), detailed procedural notes including catheterization techniques and locations, hemodynamic measurements, blood gas results, angiography images and reports, and post-procedure assessment notes.
** Thorough documentation is crucial for proper reimbursement. Ensure that all procedures and services rendered are accurately reported with appropriate codes and modifiers. Always refer to the most current CPT manual, NCCI edits, and payer-specific guidelines for accurate billing and coding practices.
- Revenue Code: 0360, 0361, 0362 (depending on the specific payer and the place of service)
- RVU: RVUs vary by location and payer. Consult your local Medicare Physician Fee Schedule for current values.
- Global Days: The global period for this procedure is not explicitly defined in the CPT code descriptions.Billing practices will depend on payer-specific policies.
- Payment Status: Active
- Modifier TC rule: Modifier TC is not applicable to this code.
- Fee Schedule: Historical fee schedules for this code can vary significantly based on location and payer.Consult payer-specific fee schedules and historical data.
- Specialties:Cardiology, Pediatric Cardiology, Cardiac Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center