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An injection procedure is conducted during cardiac catheterization to achieve selective opacification of aortocoronary venous or arterial bypass grafts. This procedure is particularly relevant for patients with congenital cardiac anomalies. During the process, a catheter is carefully positioned within the venous or arterial bypass graft, which may include grafts such as the aortocoronary saphenous vein, free radial artery, or free mammary artery. Once the catheter is in place, contrast media is injected to enhance the visibility of the grafts. This allows for the visualization of the bypass grafts and the acquisition of selective angiograms. If further evaluation is necessary, the catheter can be repositioned to access additional bypass grafts, and the injection procedure is repeated to ensure comprehensive imaging. The resulting angiograms are meticulously reviewed by the physician, who then provides a written interpretation of the findings. It is important to note that this code should be reported separately in addition to the primary procedure code for the cardiac catheterization performed on the patient.
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The injection procedure coded as CPT® 93564 is indicated for patients undergoing cardiac catheterization who require detailed evaluation of aortocoronary venous or arterial bypass grafts. This includes patients with congenital heart anomalies where visualization of the grafts is essential for assessing their patency and function. The procedure is particularly relevant for those with grafts such as the aortocoronary saphenous vein, free radial artery, or free mammary artery, as well as in situ arterial conduits like the internal mammary artery. The need for this procedure arises when there is a clinical suspicion of graft complications or when further information is necessary to guide treatment decisions.
The procedure begins with the positioning of a catheter within the venous or arterial bypass graft. This is a critical step, as accurate placement is necessary for effective visualization. Once the catheter is correctly positioned, contrast media is injected into the graft. This contrast agent enhances the visibility of the graft on imaging studies, allowing for the selective opacification of the bypass graft. Following the initial injection, selective angiograms are obtained, which provide detailed images of the graft's structure and function. If additional bypass grafts require evaluation, the catheter is carefully repositioned to access these grafts. The injection and imaging process is repeated for each graft that needs to be assessed. After all necessary angiograms have been obtained, the physician reviews the images and prepares a written interpretation of the findings, which is essential for documenting the results of the procedure.
After the injection procedure is completed, the patient may be monitored for any immediate complications related to the catheterization and injection of contrast media. It is essential to assess the patient for any adverse reactions to the contrast agent, as well as to ensure that the catheter insertion site is stable and without signs of bleeding or infection. The physician's written interpretation of the angiograms will be documented in the patient's medical record, providing critical information for ongoing management and treatment planning. Follow-up care may include additional imaging or interventions based on the findings from the procedure.
| Short Descr | NJX CGEN CAR CATH SLCTV OPAC | Medium Descr | NJX DRG CGEN C-CATHJ SLCTV OPACIFICATION S&I | Long Descr | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective opacification of aortocoronary venous or arterial bypass graft(s) (eg, aortocoronary saphenous vein, free radial artery, or free mammary artery graft) to one or more coronary arteries and in situ arterial conduits (eg, internal mammary), whether native or used for bypass to one or more coronary arteries during congenital heart catheterization, when performed (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 47 - Diagnostic cardiac catheterization, coronary arteriography |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 93582 | MPFS Status: Active Code APC J1 Percutaneous transcatheter closure of patent ductus arteriosus | 93593 | MPFS Status: Carrier Priced APC J1 Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; normal native connections | 93594 | MPFS Status: Carrier Priced APC J1 Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; abnormal native connections | 93595 | MPFS Status: Carrier Priced APC J1 Left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone, normal or abnormal native connections | 93596 | MPFS Status: Carrier Priced APC J1 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 | 93597 | MPFS Status: Carrier Priced APC J1 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); abnormal native connections | 92973 | Addon Code Resequenced Code MPFS Status: Active Code APC N CPT Assistant Article Illustration for Code Percutaneous transluminal coronary thrombectomy mechanical (List separately in addition to code for primary procedure) | 92978 | Addon Code CPT Resequenced MPFS Status: Carrier Priced APC N ASC N1 CPT Assistant Article Illustration for Code Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel (List separately in addition to code for primary procedure) | 93571 | Addon Code MPFS Status: Carrier Priced APC N ASC N1 CPT Assistant Article Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; initial vessel (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. |
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Action
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Notes
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| 2023-01-01 | Note | Short and medium descriptions changed. |
| 2022-01-01 | Changed | First appearance of guideline change in codebook. |
| 2021-06-07 | Changed | New guideline added per CPT errata. |
| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2011-01-01 | Added | Added |
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