93582

Percutaneous Transcatheter Closure of Patent Ductus Arteriosus

CPT 93582 describes a percutaneous transcatheter procedure designed to close a patent ductus arteriosus (PDA). The PDA is a persistent opening between the two major blood vessels leading from the heart: the aorta and the pulmonary artery. Normally, this vessel closes shortly after birth. If it remains open, it can lead to pulmonary over-circulation, heart failure, or endocarditis. The procedure begins with obtaining percutaneous vascular access, typically through the femoral vein or femoral artery. Using fluoroscopic guidance, catheters are advanced into the heart and through the ductus arteriosus. Aortography is performed to characterize the morphology, length, and narrowest diameter of the PDA. Based on these measurements, a specific closure device—such as a nitinol plug, a vascular occluder, or a series of coils—is selected. The device is delivered through a sheath and positioned across the ductus. Once correct placement is confirmed via repeat angiography and pressure measurements, the device is released. This procedure includes all vascular access, catheter placements, cardiac catheterization, and all necessary imaging (angiography and radiological supervision and interpretation) required to perform the closure. It is considered a definitive treatment that avoids the morbidity associated with surgical ligation via thoracotomy. It is performed in a cardiac catheterization laboratory by an interventional cardiologist, often requiring general anesthesia or deep sedation, particularly in pediatric populations.

Clinical Indications

  • Hemodynamically significant left-to-right shunt (Qp:Qs ratio > 1.5:1)
  • Symptomatic congestive heart failure in infants
  • Failure to thrive related to cardiac volume overload
  • Evidence of left atrial or left ventricular enlargement
  • Pulmonary hypertension secondary to PDA flow
  • Prior episode of endarteritis associated with the ductus
  • Prevention of Eisenmenger syndrome in patients with reversible pulmonary vascular resistance

Procedure Steps

  1. Establish percutaneous vascular access via the femoral vein and/or femoral artery.
  2. Advance catheters through the right heart and into the pulmonary artery under fluoroscopic guidance.
  3. Perform a right heart catheterization to measure pulmonary artery pressures and cardiac output.
  4. Cross the patent ductus arteriosus (PDA) with a guidewire and catheter to reach the descending aorta.
  5. Perform a selective aortogram to define the size, shape (Krichenko classification), and orientation of the PDA.
  6. Select an appropriately sized occlusion device, such as a nitinol-based occluder or stainless steel coils.
  7. Introduce a delivery sheath across the PDA and deploy the device into position.
  8. Perform repeat angiography and pressure monitoring to assess for residual shunts or narrowing of the aorta/pulmonary artery.
  9. Release the device from the delivery cable once optimal position and stability are confirmed.
  10. Remove all catheters and sheaths and achieve hemostasis at the puncture site.

Coding Guidelines

  • Code 93582 includes all diagnostic cardiac catheterization and selective catheterization required to perform the closure.
  • Do not report 93582 in conjunction with 93451-93461, 93530-93533 (Congenital Cath), or 93563-93565 (Angiography) for the same session.
  • Radiological supervision and interpretation related to the closure are included and should not be reported separately.
  • Vascular access and closure of the access site (e.g., femoral artery/vein) are inherent to the procedure.
  • If the procedure is attempted but the device cannot be successfully deployed, append modifier 53 (Discontinued Procedure) or 52 (Reduced Services) as appropriate.

Associated ICD-10 Codes