How To Use CPT Code 93590

CPT 93590 describes the percutaneous transcatheter closure of paravalvular leak around the mitral valve using an occlusion device. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 93590?

CPT 93590 can be used to describe the percutaneous transcatheter closure of paravalvular leak around the mitral valve using an occlusion device. This code is used when the provider inserts the first occlusion device to close the leak in the mitral valve, which is the valve between the left atrium and left ventricle of the heart.

2. Official Description

The official description of CPT code 93590 is: ‘Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, mitral valve.’ This code should not be reported in conjunction with CPT code 93462 for transseptal puncture. If transapical puncture is performed in conjunction with CPT 93590, use CPT code 93462.

3. Procedure

1. The provider administers an antibiotic to prevent endocarditis, an infection of the heart valves or the tissue layer that lines the heart chambers.
2. The procedure is typically performed under both transesophageal echocardiography (TEE) and fluoroscopic guidance.
3. The provider makes a small incision through the skin over the heart and into the apex of the left ventricle.
4. A catheter is inserted through the incision or between two ribs to access the mitral valve.
5. A wire is advanced through the catheter into the left ventricle, and a sheath is placed over the guide wire.
6. Heparin is administered to prevent blood clots.
7. A new catheter is advanced through the sheath toward the defect in the valve.
8. An occluding device is inserted through the sheath into the atrium to the valve defect to close off the leak.
9. If the first device doesn’t completely close the leak, a second occluder may be inserted.
10. Protamine is administered to reverse the effects of heparin.
11. Pressure is applied over the percutaneous incision site to achieve hemostasis.
12. The provider uses imaging guidance to confirm closure, removes all instruments, checks for bleeding, and closes the incision.

4. Qualifying circumstances

CPT 93590 is used for patients with paravalvular leak around the mitral valve that requires closure using an occlusion device. The procedure is performed by a provider who is appropriately trained and qualified to perform percutaneous transcatheter closures. The patient must meet the criteria for the procedure, and the provider must use imaging guidance during the procedure.

5. When to use CPT code 93590

CPT code 93590 should be used when the provider performs the percutaneous transcatheter closure of paravalvular leak around the mitral valve using an occlusion device as the initial procedure. It should not be reported in conjunction with CPT code 93462 for transseptal puncture. If transapical puncture is performed in conjunction with CPT 93590, use CPT code 93462.

6. Documentation requirements

To support a claim for CPT 93590, the provider must document the following information:

• Patient’s diagnosis and the need for percutaneous transcatheter closure of paravalvular leak
• Details of the procedure, including the use of imaging guidance
• Date of the procedure
• Specific occlusion device used
• Administration of antibiotic and heparin
• Administration of protamine
• Confirmation of closure and absence of bleeding
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 93590, ensure that the procedure meets the criteria for percutaneous transcatheter closure of paravalvular leak around the mitral valve using an occlusion device. Do not report CPT 93590 in conjunction with CPT code 93462 for transseptal puncture. If transapical puncture is performed in conjunction with CPT 93590, use CPT code 93462. It is important to check with the payer for their specific reporting requirements and to consider reporting any additional occlusion devices separately using CPT code 93592.

8. Historical information

CPT 93590 was added to the Current Procedural Terminology system on January 1, 2017. There have been no updates to the code since its addition.

9. Examples

1. A provider performs percutaneous transcatheter closure of paravalvular leak around the mitral valve using an occlusion device for a patient with a diagnosed paravalvular leak.
2. During the procedure, the provider uses imaging guidance to position the occlusion device and confirms closure of the leak.
3. After the procedure, the provider documents the details of the procedure, including the specific occlusion device used and the absence of bleeding.
4. The provider signs the documentation to support the claim for CPT 93590.
5. Another provider performs percutaneous transcatheter closure of paravalvular leak around the mitral valve using an occlusion device for a different patient with a diagnosed paravalvular leak.