93580

Percutaneous Transcatheter Closure of Congenital Interatrial Communication

CPT 93580 describes a complex percutaneous procedure designed to close congenital openings between the left and right atria, such as Secundum Atrial Septal Defects (ASD) or a Patent Foramen Ovale (PFO). These communications allow oxygenated and deoxygenated blood to mix, potentially leading to right-sided heart volume overload, pulmonary hypertension, or paradoxical emboli resulting in cryptogenic strokes. The procedure is performed in a cardiac catheterization laboratory, typically under moderate sedation or general anesthesia. It begins with obtaining venous access, typically through the femoral vein. A delivery sheath is advanced under fluoroscopic and often echocardiographic guidance—such as Transesophageal Echocardiography (TEE) or Intracardiac Echocardiography (ICE)—into the right atrium and across the defect into the left atrium. A right heart catheterization is an integral component of this procedure, used to measure intracardiac pressures, evaluate the shunt fraction (Qp:Qs ratio), and assess pulmonary vascular resistance. Once the defect's size is confirmed—frequently using balloon sizing techniques—a self-expanding occluder device, typically made of nitinol mesh and polyester fabric, is deployed. The device consists of two discs: one positioned on the left atrial side and the other on the right atrial side, effectively sandwiching the septal wall and sealing the hole. Before permanent release, the clinician performs a 'Minnesota tug' or stability check to ensure the device is securely seated and uses imaging to confirm the absence of a significant residual shunt and ensure the device does not interfere with adjacent structures like the atrioventricular valves, coronary sinus, or pulmonary veins. This minimally invasive approach has largely replaced open-heart surgery for suitable anatomical candidates, offering significantly shorter recovery times and lower morbidity.

Clinical Indications

  • Secundum atrial septal defect (ASD) with evidence of right ventricular volume overload
  • Patent foramen ovale (PFO) in patients with a history of cryptogenic stroke
  • Paradoxical systemic embolism
  • Platypnea-orthodeoxia syndrome
  • Significant left-to-right shunt with a Qp:Qs ratio ≥ 1.5:1
  • Pulmonary hypertension associated with a repairable interatrial communication
  • Prevention of recurrent transient ischemic attacks (TIA) when associated with PFO

Procedure Steps

  1. Obtain percutaneous venous access, usually via the right femoral vein using the Seldinger technique.
  2. Perform a standard right heart catheterization to measure baseline hemodynamics including pulmonary artery pressure and wedge pressure.
  3. Perform an oximetry run to calculate the shunt fraction (Qp:Qs).
  4. Traverse the interatrial communication (ASD or PFO) using a multi-purpose catheter and a guidewire.
  5. Exchange for a sizing balloon catheter to determine the stretched diameter of the defect under fluoroscopic and echocardiographic guidance.
  6. Select an appropriately sized occluder device based on the measured defect diameter and septal rims.
  7. Advance the delivery sheath into the left atrium.
  8. Deploy the left atrial disc of the occluder device and pull it snugly against the atrial septum.
  9. Deploy the right atrial disc to sandwich the septum.
  10. Perform echocardiographic (TEE or ICE) and fluoroscopic assessment to check for residual shunts and device stability.
  11. Perform a 'tug test' to ensure the device is not mobile or at risk of embolization.
  12. Release the device from the delivery cable once optimal positioning is confirmed.
  13. Remove all catheters and sheaths and achieve hemostasis at the access site.

Coding Guidelines

  • CPT 93580 includes right heart catheterization; do not report 93451, 93453, 93456-93461 in conjunction with this code.
  • The code includes imaging guidance (fluoroscopy and ultrasound) when performed by the same physician.
  • If Intracardiac Echocardiography (ICE) is performed, CPT 93662 may be reported as an add-on code, though some payer policies may bundle this.
  • Do not report 93580 in conjunction with 93581 (VSD closure).
  • If a diagnostic left heart catheterization is performed for separate indications, it may be reported with a modifier, but check specific NCCI edits.
  • Transesophageal echocardiography (TEE) codes (93312-93317) should only be reported separately if performed by a different physician (e.g., an anesthesiologist or a separate imaging cardiologist).

Associated ICD-10 Codes