How To Use CPT Code 0645T

CPT 0645T describes the transcatheter implantation of a coronary sinus reduction device, including various procedures such as vascular access and closure, right heart catheterization, venous angiography, coronary sinus angiography, imaging guidance, and supervision and interpretation. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0645T?

CPT 0645T can be used to describe the transcatheter implantation of a coronary sinus reduction device. This procedure involves the insertion of a reduction device into the coronary sinus, which is the largest cardiac venous structure. The device helps to increase pressure in the coronary sinus, redistributing blood to the heart muscle that may not be receiving enough oxygen-rich blood. This code includes various procedures such as vascular access and closure, right heart catheterization, venous angiography, coronary sinus angiography, imaging guidance, and supervision and interpretation.

2. Official Description

The official description of CPT code 0645T is: ‘Transcatheter implantation of coronary sinus reduction device including vascular access and closure, right heart catheterization, venous angiography, coronary sinus angiography, imaging guidance, and supervision and interpretation, when performed.’

3. Procedure

1. The provider begins by preparing and anesthetizing the patient.
2. Vascular access is obtained, possibly with the assistance of ultrasound guidance.
3. The provider navigates a catheter through the blood vessels to access the heart.
4. Right heart catheterization and coronary sinus catheterization are performed.
5. Angiography is used to examine the structures, including the coronary sinus.
6. If necessary, interventions may be performed in the coronary sinus.
7. The provider uses imaging guidance to place the coronary sinus reduction device.
8. Intracardiac echocardiography may be used during the procedure.
9. After placing the device and removing catheters and wires, the provider closes the access site.

4. Qualifying circumstances

CPT 0645T is appropriate for patients who require the implantation of a coronary sinus reduction device to help alleviate angina caused by coronary artery disease. The procedure is performed by a provider who has the necessary qualifications and expertise. It is important to note that CPT 0645T should not be reported in conjunction with certain other codes, as specified in the notes.

5. When to use CPT code 0645T

CPT code 0645T should be used when a provider performs the transcatheter implantation of a coronary sinus reduction device. It is important to ensure that the procedure includes all the necessary components described in the code description. Additionally, it is crucial to review the notes to determine if there are any specific circumstances in which CPT 0645T should not be used in conjunction with other codes.

6. Documentation requirements

To support a claim for CPT 0645T, the provider must document the following information:

• Indication for the procedure and the patient’s diagnosis
• Details of the procedures performed, including vascular access, closure, right heart catheterization, venous angiography, coronary sinus angiography, and any interventions in the coronary sinus
• Imaging guidance and supervision and interpretation, if applicable
• Date of the procedure and the duration of each component
• Any complications or adverse events that occurred

7. Billing guidelines

When billing for CPT 0645T, it is important to ensure that all the necessary procedures and components are included in the claim. The provider should review the notes to determine if there are any specific codes that should not be reported in conjunction with CPT 0645T. Additionally, if diagnostic cardiac catheterization services are performed during the same session, the appropriate diagnostic codes should be reported with modifier 59 to indicate a separate and distinct procedural service from the transcatheter coronary sinus reduction implantation.

8. Historical information

CPT 0645T was added to the Current Procedural Terminology system on July 1, 2021. As of now, there have been no updates or changes to the code since its addition.

9. Examples

1. A provider performs the transcatheter implantation of a coronary sinus reduction device for a patient with coronary artery disease to alleviate angina symptoms.
2. During the procedure, the provider uses imaging guidance and performs right heart catheterization, venous angiography, and coronary sinus angiography to ensure proper device placement.
3. A patient with coronary artery disease undergoes the transcatheter implantation of a coronary sinus reduction device, which includes vascular access, closure, and supervision and interpretation.
4. The provider performs the procedure for a patient who has experienced a change in their clinical condition since a prior study, necessitating the use of CPT 0645T for a full diagnostic evaluation.
5. A patient with angina undergoes the transcatheter implantation of a coronary sinus reduction device, which includes right heart catheterization, venous angiography, and interventions in the coronary sinus.
6. During the procedure, the provider uses intracardiac echocardiography to guide the placement of the coronary sinus reduction device.
7. A patient with coronary artery disease undergoes the transcatheter implantation of a coronary sinus reduction device, which includes imaging guidance and supervision and interpretation.
8. The provider performs the procedure for a patient who has inadequate visualization of the anatomy and pathology, necessitating a full diagnostic study in addition to the device implantation.
9. A patient with angina undergoes the transcatheter implantation of a coronary sinus reduction device, which includes vascular access, closure, and right heart catheterization.
10. During the procedure, the provider performs coronary sinus angiography to assess and confirm the positioning and function of the device.