How To Use CPT Code 99190

CPT 99190 refers to the assembly and operation of a pump with an oxygenator or heat exchanger, a critical procedure in cardiac surgeries that involves the circulation and oxygenation of blood outside the body. This service is billed for each hour of operation and may include monitoring of the patient’s blood pressure and performing an electrocardiogram (ECG). The use of a pump-oxygenator or heat exchanger is essential in maintaining blood flow and oxygenation during complex surgical procedures, ensuring the patient’s vital functions are supported while the heart is temporarily bypassed.

1. What is CPT code 99190?

CPT code 99190 represents the assembly and operation of a mechanical pump-oxygenator or heat exchanger, which is a vital component in cardiopulmonary bypass procedures. This code is utilized when healthcare providers set up and manage a system that takes over the functions of the heart and lungs during surgery. The purpose of this procedure is to ensure that oxygen-depleted blood is effectively removed from the body and replaced with oxygen-rich blood, allowing surgeons to operate on the heart without compromising the patient’s overall circulation and oxygenation. The clinical relevance of this code lies in its application during high-stakes cardiac surgeries, where maintaining proper blood flow and oxygen levels is crucial for patient safety and surgical success.

2. Qualifying Circumstances

This CPT code can be used in specific circumstances where a mechanical pump-oxygenator or heat exchanger is necessary for patient care during surgical procedures. It is appropriate in scenarios such as open-heart surgeries, where the heart must be temporarily stopped, and blood circulation must be maintained artificially. Limitations include situations where the procedure does not require external circulation support or when alternative methods of oxygenation are employed. The use of this code is inappropriate in cases where the patient does not undergo procedures necessitating cardiopulmonary bypass or when the assembly and operation of the equipment are not performed by qualified personnel.

3. When To Use CPT 99190

CPT code 99190 is used when a provider is actively involved in the assembly and operation of a pump-oxygenator or heat exchanger for each hour of service. It is essential to document the duration of the operation accurately, as billing is based on hourly increments. This code can be used in conjunction with other surgical codes that describe the primary procedure being performed, provided that the services are distinct and necessary for the surgical intervention. However, it cannot be used with codes that describe similar services or procedures that do not require the use of a pump-oxygenator or heat exchanger.

4. Official Description of CPT 99190

Official Descriptor: Assembly and operation of pump with oxygenator or heat exchanger (with or without ECG and/or pressure monitoring); each hour.

5. Clinical Application

The clinical context for CPT code 99190 is primarily found in cardiac surgery, where the use of a pump-oxygenator or heat exchanger is critical for patient survival and successful surgical outcomes. This procedure allows for the safe manipulation of the heart while ensuring that the patient’s blood is continuously circulated and oxygenated. The importance of this service cannot be overstated, as it provides the necessary support for patients undergoing complex surgeries, allowing surgeons to perform intricate procedures without the risk of compromising the patient’s hemodynamic stability.

5.1 Provider Responsibilities

The provider’s responsibilities during the procedure include assembling the pump-oxygenator or heat exchanger under sterile conditions, ensuring that all components are properly connected and functioning. This involves following established protocols and conducting thorough checklist verifications to confirm the sterility of components, the adequacy of electrical connections, and the reliability of gas supplies. The provider must also prepare the priming solution, test the system’s alarms, and verify the functionality of the water supply system. Once the system is operational, the provider monitors the patient’s vital signs, including blood pressure and ECG, to ensure the patient’s safety throughout the procedure.

5.2 Unique Challenges

One of the unique challenges associated with the assembly and operation of a pump-oxygenator or heat exchanger is the need for precise coordination and attention to detail. Any malfunction or oversight in the setup can lead to severe complications for the patient. Additionally, the provider must be adept at troubleshooting any issues that arise during operation, which requires a deep understanding of the equipment and its functions. The high-stakes environment of cardiac surgery adds to the complexity, as the provider must remain focused and responsive to the dynamic needs of the surgical team and the patient.

5.3 Pre-Procedure Preparations

Before the procedure, the provider must conduct thorough evaluations and tests to ensure that the pump-oxygenator or heat exchanger is ready for use. This includes inspecting all components for sterility, verifying that the equipment is functioning correctly, and preparing the priming solution. The provider must also familiarize themselves with the specific surgical procedure being performed and the patient’s medical history to anticipate any potential complications that may arise during the operation.

5.4 Post-Procedure Considerations

After the procedure, the provider is responsible for monitoring the patient’s recovery and ensuring that the pump-oxygenator or heat exchanger is safely dismantled and cleaned. Follow-up care may include assessing the patient’s vital signs and overall condition to identify any complications that may arise from the use of the equipment. The provider must also document the procedure thoroughly, including the duration of operation and any observations made during the surgery, to ensure accurate billing and continuity of care.

6. Relevant Terminology

Electrocardiogram (ECG): A test that records the electrical activity of the heart, providing valuable information about the heart’s rhythm and identifying any potential problems.

7. Clinical Examples

1. A patient undergoing coronary artery bypass grafting requires a pump-oxygenator to maintain blood flow while the heart is temporarily stopped.

2. During a valve replacement surgery, the surgical team utilizes a heat exchanger to regulate the temperature of the blood being circulated.

3. A pediatric patient with congenital heart defects requires the assembly of a pump-oxygenator for a complex surgical repair.

4. In a heart transplant procedure, the provider operates a mechanical pump to ensure adequate blood circulation while the donor heart is being prepared.

5. A patient undergoing aortic aneurysm repair requires continuous monitoring of blood pressure and ECG while on the pump-oxygenator.

6. During a minimally invasive cardiac procedure, the provider uses a heat exchanger to maintain normothermia in the patient.

7. A patient with severe heart failure is placed on a pump-oxygenator during a high-risk surgical intervention to repair the heart.

8. In a complex arrhythmia surgery, the provider monitors the patient’s ECG while managing the pump-oxygenator system.

9. A patient undergoing a left ventricular assist device implantation requires the use of a pump-oxygenator to support circulation.

10. During a redo cardiac surgery, the provider assembles and operates a heat exchanger to ensure proper blood oxygenation throughout the procedure.