How To Use CPT Code 93591

CPT 93591 describes the percutaneous transcatheter closure of paravalvular leak using an initial occlusion device for the aortic valve. 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 93591?

CPT 93591 can be used to describe the percutaneous transcatheter closure of a paravalvular leak around the aortic valve using an initial occlusion device. This procedure involves inserting a special device through a catheter that is inserted percutaneously, or through a small incision in the skin over the heart. The device is used to close off the leak in the aortic valve, which is the valve connecting the heart to the aorta.

2. Official Description

The official description of CPT code 93591 is: ‘Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, aortic valve.’ This code specifically refers to the insertion of the first occlusion device to close a leak in the aortic valve.

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. Under imaging guidance, the provider makes a small incision through the skin over the femoral artery in the groin area and inserts a catheter.
3. A wire is advanced through the catheter into the left ventricle, and a sheath is placed over the guide wire.
4. The provider administers heparin to prevent blood clots and advances a new catheter through the sheath to the valve defect.
5. An occluding device is inserted through the sheath to the valve defect to close off the leak.
6. If the first device doesn’t completely close the leak, a second occluder may be inserted.
7. The provider administers protamine to reverse the effects of heparin.
8. Imaging guidance is used to confirm closure, and all instruments are removed.
9. The provider checks for bleeding and closes the incision.

4. Qualifying circumstances

CPT 93591 is performed on patients with a paravalvular leak around the aortic valve. This procedure is appropriate for patients who require closure of the leak using an initial occlusion device. The provider must use imaging guidance, such as transesophageal echocardiography (TEE) or fluoroscopy, to perform the procedure. The patient should also be appropriately prepped and anesthetized.

5. When to use CPT code 93591

CPT code 93591 should be used when the provider performs the percutaneous transcatheter closure of a paravalvular leak around the aortic valve using an initial occlusion device. This code is specifically for the first occlusion device inserted to close the leak. If additional occlusion devices are inserted, they should be reported separately using CPT code 93592. It is important to note that CPT code 93591 should not be reported if the procedure involves the closure of a leak in the mitral valve, as a different code (93590) should be used in that case.

6. Documentation requirements

To support a claim for CPT code 93591, the provider must document the following information:

• Patient’s diagnosis and the presence of a paravalvular leak around the aortic valve
• Use of imaging guidance, such as TEE or fluoroscopy
• Date of the procedure
• Specific details of the procedure, including the insertion of the occlusion device
• Confirmation of closure using imaging guidance
• Administration of antibiotics, heparin, and protamine
• Any additional occlusion devices inserted, if applicable
• Confirmation of closure, removal of instruments, and closure of the incision

7. Billing guidelines

When billing for CPT code 93591, ensure that the procedure involves the percutaneous transcatheter closure of a paravalvular leak around the aortic valve using an initial occlusion device. It is important to use the appropriate code for any additional occlusion devices inserted (93592). CPT code 93591 should not be reported with other codes for the same procedure. It is also important to follow any specific guidelines provided by the payer or coding guidelines.

8. Historical information

CPT code 93591 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 the percutaneous transcatheter closure of a paravalvular leak around the aortic valve using an initial occlusion device for a patient with aortic valve regurgitation.
2. During the procedure, the provider uses fluoroscopic guidance to insert the occlusion device and confirms closure using imaging guidance.
3. The patient’s diagnosis and the details of the procedure are documented, including the administration of antibiotics and heparin.
4. The provider removes all instruments, checks for bleeding, and closes the incision.
5. Another provider performs the percutaneous transcatheter closure of a paravalvular leak around the aortic valve using an initial occlusion device for a patient with a prosthetic aortic valve.
6. Imaging guidance, such as TEE, is used to guide the procedure and confirm closure.
7. The documentation includes the date of the procedure, confirmation of closure, and any additional occlusion devices inserted.
8. A different provider performs the percutaneous transcatheter closure of a paravalvular leak around the aortic valve using an initial occlusion device for a patient with aortic stenosis.
9. The procedure is performed under fluoroscopic guidance, and the closure is confirmed using imaging guidance.
10. The documentation includes the patient’s diagnosis, details of the procedure, and closure confirmation.