CPT® Code 92992

Code deleted, see 33741.

Official Description

Atrial septectomy or septostomy; transvenous method, balloon (eg, Rashkind type) (includes cardiac catheterization)

Common Language Description

Atrial septectomy or septostomy is a specialized palliative procedure aimed at enhancing oxygen saturation levels in patients diagnosed with complete transposition of the great arteries, a congenital heart defect. This procedure is performed using a transvenous method, which involves accessing the heart through a vein rather than through an incision in the chest. The technique described by CPT® Code 92992 specifically refers to the use of a balloon, commonly known as the Rashkind balloon septostomy. During this procedure, a small incision is made in the groin area to expose the femoral vein, which serves as the access point for the catheter. A balloon-tipped catheter is then carefully threaded through the femoral vein and navigated to the right atrium of the heart. Once in position, the catheter is advanced through the foramen ovale, a natural opening between the atria, into the left atrium. The balloon is inflated within the left atrium and subsequently pulled back across the atrial septum, resulting in a tear that enlarges the existing hole in the interatrial septum. This enlargement allows for improved blood flow and oxygenation, which is critical for patients with this condition. The procedure is performed under imaging guidance to ensure accurate placement and effectiveness, and it is essential for medical coders and billers to understand the nuances of this procedure for accurate coding and billing purposes.

1. Indications

The atrial septectomy or septostomy procedure, as described by CPT® Code 92992, is indicated for specific clinical scenarios, particularly in patients with congenital heart defects. The primary indications include:

Complete Transposition of the Great Arteries - This condition involves the aorta and pulmonary artery being switched, leading to inadequate oxygenation of blood. The procedure aims to improve oxygen saturation by creating a larger opening between the atria.

2. Procedure

The procedure for atrial septectomy or septostomy using the transvenous balloon method involves several critical steps:

Step 1: Accessing the Femoral Vein - The procedure begins with the patient positioned appropriately, and a small incision is made in the groin area to access the femoral vein. This access point is crucial for the subsequent steps of the procedure.
Step 2: Inserting the Balloon-Tipped Catheter - A puncture is made in the femoral vein, and a balloon-tipped catheter is carefully threaded through the vein. The catheter is navigated through the venous system to reach the right atrium of the heart.
Step 3: Advancing Through the Foramen Ovale - Once the catheter is in the right atrium, it is advanced through the foramen ovale, which is a natural opening between the right and left atria, into the left atrium. This step is critical for the subsequent inflation of the balloon.
Step 4: Inflating the Balloon - The balloon at the tip of the catheter is inflated while it is positioned in the left atrium. This inflation is designed to create a significant force against the atrial septum.
Step 5: Pulling Back the Catheter - After inflation, the catheter is forcefully pulled back across the atrial septum through the foramen ovale. This action causes a tear in the atrial septum, effectively enlarging the existing hole and facilitating improved blood flow between the atria.

3. Post-Procedure

Following the atrial septectomy or septostomy procedure, patients are typically monitored for any immediate complications, such as bleeding or arrhythmias. Recovery may involve a short hospital stay where vital signs and overall stability are assessed. Patients may require follow-up imaging studies to evaluate the effectiveness of the procedure and ensure that the atrial septum remains adequately open for improved oxygenation. Additional considerations include monitoring for any signs of infection at the catheter insertion site and ensuring that the patient is stable before discharge.

Short Descr	REVISION OF HEART CHAMBER
Medium Descr	ATRIAL SEPTECT/SEPTOST TRANSVENOUS BALLOON
Long Descr	Atrial septectomy or septostomy; transvenous method, balloon (eg, Rashkind type) (includes cardiac catheterization)
Status Code	Carriers Price the Code
Global Days	000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Inpatient Procedures, not paid under OPPS
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P2F - Major procedure, cardiovascular-Other
MUE	Not applicable/unspecified.
CCS Clinical Classification	49 - Other OR heart procedures