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Question: Is it appropriate to use the CPT^庐 codes for congenital heart catheterization after a patient has had surgery to treat a congenital heart defect? My provider performed a right and left heart catheterization on a patient who was experiencing shortness of breath two weeks after a Fontan procedure for hypoplastic left heart syndrome.

Illinois Subscriber

Answer: Code selection for heart catheterizations after surgeries or procedures to treat congenital heart defects depends on three factors: whether residual defects exist, the nature of the defect, and whether the connections are normal or abnormal.  

If the defect is no longer present, such as in cases where the patient has undergone a heart transplant, cardiac catheterization codes from subsection 93451 (Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed) to 93505 (Endomyocardial biopsy) should be used. If the defect is still present, as seen with certain types of graft placements, the next step is to assess the type of defect. According to CPT^庐 guidelines, some defects, like a patent foramen ovale, are not eligible for the congenital heart catheterization codes. If the defect is still present and is not excluded by the congenital catheterization guidelines, the final factor in determining the correct code would be whether the patient has normal or abnormal native connections.

In the above scenario, it would be appropriate to use a congenital cardiac catheterization code. The Fontan procedure is typically one of the final steps in a series of staged surgeries commonly performed to treat hypoplastic left heart syndrome. In hypoplastic left heart syndrome, the left side of the heart is severely underdeveloped. The purpose of the staged procedures is to reroute deoxygenated blood returning from the body back to the lungs via direct connections to the pulmonary arteries. This bypasses the heart so that the sole working ventricle can pump blood to the body more efficiently. During a Fontan procedure, the inferior vena cava is disconnected from the heart and anastomosed directly to the pulmonary arteries. Although corrective surgery has been performed, the underdeveloped left ventricle is still intact.

This redirection of flow results in abnormal connections; therefore code 93597 (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) would be the most appropriate.

Brittany Sowards, BA, CPC, CPMA, CCC, CCVTC, Clinical Documentation Specialist