2025 CPT code 93583
(Active) Effective Date: N/A Revision Date: N/A Cardiovascular Procedure - Cardiac Catheterization Medicine Services and Procedures > Cardiovascular Procedures Feed
Percutaneous transcatheter septal reduction therapy (e.g., alcohol septal ablation) including temporary pacemaker insertion when performed.
Modifiers may be applicable depending on the circumstances of the procedure. For example, modifier 22 might be used if the procedure is significantly more complex than usual, or modifier 51 if multiple procedures are performed on the same day.Consult the CPT manual for detailed modifier guidelines.
Alcohol septal ablation is medically necessary for patients with symptomatic HOCM who have not responded to medical management and are at high risk for sudden cardiac death or other significant cardiovascular events.The procedure is indicated when there's significant outflow tract obstruction and symptoms such as dyspnea, angina, or syncope despite optimal medical therapy.
The physician is responsible for all aspects of the procedure, from pre-procedural preparation and sedation to vascular access, catheter placement and manipulation, hemodynamic measurements (if performed), temporary pacemaker insertion (if needed), alcohol injection (or other septal reduction method), monitoring the patient's response, post-procedural care and hemostasis.
In simple words: This procedure uses a catheter (a thin tube) inserted through a small incision to reduce a thickened area of heart muscle causing blockage.The doctor uses imaging to guide the catheter to the affected area and uses alcohol (or another substance) to create a small, controlled injury to reduce the blockage. A temporary pacemaker may be inserted.
Percutaneous transcatheter septal reduction therapy, such as alcohol septal ablation, involves a catheter-based intervention to create a controlled infarction in an area of abnormally thick heart muscle between the ventricles causing an obstruction.The procedure includes vascular access, catheter advancement to the heart under imaging guidance, pressure measurements (if performed), temporary transvenous pacemaker insertion (when performed), identification of the first septal perforator, balloon catheter advancement, contrast injection, alcohol injection (or other ablative method) to produce the controlled infarction, monitoring of the patient's response, additional angiography (if needed), instrument removal, and hemostasis at the access site(s).Left anterior descending coronary angiography is included for roadmapping purposes to guide the intervention.
Example 1: A 55-year-old male presents with severe hypertrophic obstructive cardiomyopathy (HOCM) causing significant symptoms.Alcohol septal ablation is chosen as the treatment option.The procedure is performed using a transfemoral approach.Temporary pacing is required. , A 62-year-old female with HOCM experiences recurrent syncope. She undergoes alcohol septal ablation.During the procedure, the physician performs selective coronary angiography for road mapping and to assess for any significant coronary artery disease that might complicate the septal ablation. No temporary pacemaker is needed. , A 48-year-old male with HOCM undergoing alcohol septal ablation experiences a significant drop in blood pressure during the procedure. The physician pauses the ablation and performs a diagnostic cardiac catheterization to evaluate the hemodynamic parameters further before resuming the procedure. Temporary pacing is not needed.
Detailed history and physical exam; echocardiogram showing HOCM with significant outflow tract obstruction; coronary angiography (if performed); hemodynamic data (if obtained); procedural report with details of catheter placement, alcohol injection volume and location, and assessment of septal thickness; and post-procedure echocardiogram.
** The inclusion of left anterior descending coronary angiography is inherent to the procedure for roadmapping.Do not report this separately.Consider the use of appropriate modifiers to reflect the complexity or extent of the procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Cardiology, Cardiovascular Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center