How To Use CPT Code 93596

CPT 93596 describes the right and left heart catheterization procedure for patients born with congenital heart defects and normal native connections. 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 93596?

CPT 93596 is used to describe the right and left heart catheterization procedure for patients with congenital heart defects and normal native connections. This code is specifically for patients who were born with one or more heart defects and have blood flow that follows the expected course through the heart chambers and great vessels. The procedure involves navigating one or more catheters through the blood vessels to the heart and inserting the catheter(s) into the right and left sides. During the procedure, the provider may take samples to measure blood gases and perform other measurements to assess the patient’s condition.

2. Official Description

The official description of CPT code 93596 is: ‘Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone(s); normal native connections.’

3. Procedure

1. The provider prepares the patient for the procedure, ensuring that they are appropriately prepped and anesthetized.
2. A small incision is made in the arm or groin to access the target vessel and introduce a catheter.
3. If necessary, additional incisions may be made to allow access to both sides of the heart.
4. Using imaging guidance, such as fluoroscopy, the provider advances the catheter(s) via the blood vessels to the target zones of the right and left heart.
5. The provider places the catheter in one or more right-sided cardiac structures, such as the right atrium, right ventricle, or pulmonary artery, to obtain blood samples and measure blood gases.
6. If applicable, the provider may perform Fick cardiac output measurements to assess the amount of blood pumped over a specific time.
7. If the provider needs to access the left ventricle, they may use transapical puncture or transseptal puncture techniques.
8. The provider advances the catheter to the target zone of the left heart, which channels blood to the aorta.
9. The provider places the catheter in the left atrium, left ventricle, or both, and may perform hemodynamic evaluation to study the blood flow.
10. Once the procedure is complete, the provider removes the catheter and any other instruments and applies pressure at the access site(s) to prevent bleeding.

4. Qualifying circumstances

CPT 93596 is used for patients with congenital heart defects and normal native connections. These patients have one or more heart defects that were present from birth, but their blood flow follows the expected course through the heart chambers and great vessels. Examples of congenital heart defects that may qualify for this procedure include atrial septal defect, ventricular septal defect, and patent ductus arteriosus. The procedure is performed by a provider who is skilled in navigating catheters through the blood vessels and has the necessary imaging guidance to advance the catheter to the target zones.

5. When to use CPT code 93596

CPT code 93596 should be used when performing right and left heart catheterization for patients with congenital heart defects and normal native connections. It is important to ensure that the patient’s blood flow follows the expected course through the heart chambers and great vessels. If the patient has abnormal blood flow due to congenital heart disease, different codes may be appropriate. It is crucial to review the descriptors and guidelines carefully to determine the correct code for the specific patient’s condition.

6. Documentation requirements

To support a claim for CPT 93596, the provider must document the following information:

• Patient’s diagnosis of congenital heart defects and normal native connections
• Details of the procedure, including the specific structures accessed and the catheter placement
• Imaging guidance used, such as fluoroscopy
• Any blood samples taken and measurements performed during the procedure
• Hemodynamic evaluation, if applicable
• Details of any additional steps, such as transapical or transseptal puncture techniques
• Date and duration of the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 93596, it is important to ensure that the procedure is performed for patients with congenital heart defects and normal native connections. The provider should use imaging guidance, such as fluoroscopy, to advance the catheter to the target zones. It is also important to document any additional steps, such as transapical or transseptal puncture techniques, separately if performed. Review the guidelines and documentation requirements carefully to ensure accurate billing for this procedure.

8. Historical information

CPT 93596 was added to the Current Procedural Terminology system on January 1, 2022. There have been no updates to the code since its addition.

9. Examples

1. A patient with an isolated atrial septal defect undergoes right and left heart catheterization to assess the defect and measure blood gases.