Mountain State Medical Policy Bulletin |
Section: | Surgery |
Number: | S-152 |
Topic: | Transcatheter Closure Devices for Congenital Heart Defects (Amplatzer, CardioSeal) |
Effective Date: | August 1, 2005 |
Issued Date: | August 1, 2005 |
Date Last Reviewed: | 06/2005 |
Indications and Limitations of Coverage
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:
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. The implantation of the CardioSeal device should be reported under procedure code 93581. 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. |
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93580 | 93581 | 93799 |
Closure of patent foramen ovale (PFO) using a transcatheter approach with an FDA-approved device may be considered medically necessary in patients with a history of cryptogenic stroke and who have failed or are not candidates for a course of anticoagulant therapy. |
MPRM 2.02.09 |