2025 CPT code 93462
(Active) Effective Date: N/A Medicine - Cardiovascular Feed
Left heart catheterization by transseptal puncture through intact septum or by transapical puncture. This code is used in addition to the primary procedure code.
Modifiers may be applicable to 93462 depending on the specific circumstances of the procedure (e.g., modifier 52 for reduced services). Refer to current modifier guidelines for specific scenarios.
Medical necessity is established when standard left heart catheterization access is not feasible or safe. Specific clinical indications, such as previous cardiac surgeries, anatomical variations, or procedural requirements, should be documented to justify the use of transseptal or transapical puncture.
The physician performs this procedure when standard left heart catheterization access is not feasible. The physician inserts a catheter, usually through the femoral vein, and advances it to the right atrium. Using fluoroscopic guidance, the physician punctures the interatrial septum and passes the catheter into the left atrium or ventricle. Alternatively, a transapical puncture can be performed by puncturing the chest wall and inserting a needle directly into the left ventricle. This allows for pressure measurements, blood flow assessments, and other diagnostic or therapeutic interventions.
In simple words: This procedure involves accessing the left side of the heart by puncturing the wall between the heart chambers or by making a small incision between the ribs and accessing the heart directly. This method is used when the left side of the heart is difficult to reach, such as in patients with valve replacement.
Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation, including intracardiac electrophysiologic 3-dimensional mapping, intracardiac echocardiography including imaging supervision and interpretation, induction or attempted induction of an arrhythmia including left or right atrial pacing/recording, right ventricular pacing/recording, and His bundle recording, when performed.
Example 1: A patient with a history of mitral valve replacement requires left heart catheterization. Due to the altered anatomy, a transseptal puncture is performed to access the left ventricle for hemodynamic assessment., A patient with severe aortic stenosis undergoes left heart catheterization. Transapical access is chosen due to difficulties accessing the femoral artery. The catheter is advanced into the left ventricle for pressure measurements and angiography., During an electrophysiology study, a patient develops atrial fibrillation. To perform ablation, the physician performs a transseptal puncture to access the left atrium and map the electrical activity.
Documentation should include the reason for transseptal or transapical access, details of the puncture technique, hemodynamic measurements obtained, any complications encountered, and the overall outcome of the procedure. Fluoroscopic images and procedural reports are also required.
** This code represents a specialized technique used during left heart catheterization and should be appropriately documented and coded to ensure accurate reimbursement.
- Revenue Code: P2F - MAJOR PROCEDURE, CARDIOVASCULAR - OTHER
- RVU: 3.73
- Payment Status: Active
- Specialties:Cardiology, Interventional Cardiology, Cardiac Electrophysiology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Outpatient Hospital