Procedure codes 93580 and 93581 include a right heart catheterization procedure (93501, 93529-93533) as well as the injection of contrast for atrial and ventricular angiograms (93539, 93543, 93555). These codes should not be reported separately in addition to code 93580, 93581, or 93799 (duct occluder).

Amplatzer

The Amplatzer Septal Occluder is a percutaneously implanted device. Closure of secundum atrial septal defects using this device may be considered medically necessary in patients with the following indications:

• Those with echocardiographic evidence of ostium secundum atrial septal defect; and,
• Clinical evidence of right ventricular volume overload (i.e., 1.5:1 degree of left to right shunt or right ventricular enlargement).

The use of the Amplatzer device may also be considered medically necessary in patients who have undergone a fenestrated fontan procedure and now require closure of the fenestration.

If the implantation of the Amplatzer Septal Occluder device is reported for an indication other than those listed, it should be denied as not medically necessary and, therefore, not covered. A participating, preferred, or network provider cannot bill the member for the denied service.

The implantation of the Amplatzer device should be reported under procedure code 93580.

In addition, the Amplatzer Duct Occluder is a percutaneous transcatheter occlusion device.  Implantation of this device is considered medically necessary for the nonsurgical closure of patent ductus arteriosus (PDA)(747.0).

The implantation of the Amplatzer Duct Occluder device should be reported under procedure code 93799.

CardioSeal

The CardioSeal Septal Occluder is also a percutaneously implanted device which has been approved for ventricular septal defects (VSD). If the implantation of the CardioSeal device is reported for any other indication, it should be denied as not medically necessary and, therefore, not covered. A participating, preferred, or network provider cannot bill the member for the denied service.

Percutaneous transcatheter closure with implantation of the CardioSeal device should be reported under procedure code 93581.

Closure of single ventricular septal defects should be reported under codes 33681, 33684, and 33688.

Closure of multiple ventricular septal defects should be reported under codes 33675, 33676, and 33677.

Transmyocardial transcatheter closure with implant, with or without cardiopulmonary bypass, should be reported under procedure code 0166T or 0167T. However, this method of transcatheter closure is considered experimental/investigational and, therefore is not covered. A participating, preferred, or network provider can bill the member for the denied service. There are no long-term studies available.

Date Last Reviewed: 01/2007

Description

The FDA has approved several transcatheter cardiac occlusion devices (Amplatzer Septal Occluder, Amplatzer Duct Occluder,  and CardioSeal Septal Occluder) for use in minimally invasive repair of certain congenital cardiac defects. These devices offer an alternative to conventional open heart surgery.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.

MPRM 2.02.09

From the Food and Drug Administration, Journal of American Medical Association, Vol. 287, No. 5, February 6, 2002

Right Ventricular Form and Function After Percutaneous Atrial Septal Defect Device Closure, Journal of the American College of Cardiology, Vol. 37, No. 8, 2001

Comparison of Results of Closure of Secundum Atrial Septal Defect by Surgery Versus Amplatzer Septal Occluder, The American Journal of Cardiology, Vol. 88, September 1, 2001

Percutaneous Closure with Amplatzer Device is a Safe and Efficient Alternative to Surgery in Adults with Large Atrial Septal Defects, American Heart Journal, Vol. 142, No. 3, April 2001