How To Use CPT Code 33746

CPT 33746 describes the creation of a transcatheter intracardiac shunt (TIS) using stent placement for congenital cardiac anomalies. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 33746?

CPT 33746 can be used to describe the creation of a transcatheter intracardiac shunt (TIS) using stent placement for congenital cardiac anomalies. This code is used when the provider establishes effective intracardiac flow by placing one or more stents to improve blood flow in the heart. The procedure may also include left and right heart diagnostic cardiac catheterization for congenital cardiac anomalies and target zone angioplasty if necessary.

2. Official Description

The official description of CPT code 33746 is: ‘Transcatheter intracardiac shunt (TIS) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, including all imaging guidance by the proceduralist, when performed, left and right heart diagnostic cardiac catheterization for congenital cardiac anomalies, and target zone angioplasty, when performed (eg, atrial septum, Fontan fenestration, right ventricular outflow tract, Mustard/Senning/Warden baffles); each additional intracardiac shunt location (List separately in addition to code for primary procedure)’

3. Procedure

1. The provider assesses the patient’s condition and determines the need for a transcatheter intracardiac shunt.
2. If necessary, the provider performs left and right heart diagnostic cardiac catheterization to diagnose congenital cardiac anomalies.
3. The provider selects the appropriate target zone for angioplasty, if required, to pre-dilate the area where the stent will be placed.
4. The provider creates the transcatheter intracardiac shunt by placing one or more stents to establish effective intracardiac flow.
5. If necessary, the provider performs target zone angioplasty after stent placement to achieve a therapeutic result.
6. The provider withdraws the catheter and closes the access site.
7. The procedure includes all imaging guidance performed by the proceduralist.

4. Qualifying circumstances

Patients eligible to receive CPT 33746 services are those with congenital cardiac anomalies that require the creation of a transcatheter intracardiac shunt using stent placement. The procedure is performed to establish effective intracardiac flow and improve blood circulation in the heart. The provider may also perform left and right heart diagnostic cardiac catheterization to diagnose the congenital cardiac anomalies and target zone angioplasty if necessary.

5. When to use CPT code 33746

CPT code 33746 should be used when the provider creates a transcatheter intracardiac shunt using stent placement for congenital cardiac anomalies. This code should be reported once for each additional intracardiac shunt created at the same session as the primary procedure. It is important to note that CPT code 33746 should be reported in conjunction with the appropriate primary code, 33745.

6. Documentation requirements

To support a claim for CPT 33746, the provider must document the following information:

• Patient’s diagnosis and the need for a transcatheter intracardiac shunt
• Specific details of the procedure, including the number of stents placed and the target zone for angioplasty
• Date and duration of the procedure
• Imaging guidance performed by the proceduralist
• Left and right heart diagnostic cardiac catheterization findings, if performed
• Target zone angioplasty details, if performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 33746, ensure that the procedure is performed to create a transcatheter intracardiac shunt using stent placement for congenital cardiac anomalies. It is important to report this code once for each additional intracardiac shunt created at the same session as the primary procedure. CPT code 33746 should be reported in conjunction with the appropriate primary code, 33745. Do not report CPT codes 33745 and 33746 in conjunction with codes 93593, 93594, 93595, 93596, or 93597.

8. Historical information

CPT 33746 was added to the Current Procedural Terminology system on January 1, 2021. There have been no updates to the code since its addition. It is important to note that this procedure is currently listed under the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A provider creates an additional transcatheter intracardiac shunt using stent placement for a patient with congenital cardiac anomalies during the same session as the initial shunt creation.
2. A provider performs left and right heart diagnostic cardiac catheterization to diagnose congenital cardiac anomalies and creates a transcatheter intracardiac shunt using stent placement for effective intracardiac flow.
3. A provider performs target zone angioplasty after stent placement to achieve a therapeutic result in a patient with congenital cardiac anomalies.
4. A provider creates multiple intracardiac shunts using stent placement for a patient with complex congenital cardiac anomalies during the same session.