How To Use CPT Code 33745
CPT 33745 refers to the transcatheter intracardiac shunt (TIS) creation by stent placement, a specialized procedure aimed at addressing congenital cardiac anomalies. This intervention is designed to establish effective intracardiac flow, which is crucial for patients with structural heart defects. The procedure involves the use of imaging guidance to navigate catheters through the vascular system to the heart, where stents are placed to create a shunt. This code specifically denotes the initial creation of an intracardiac shunt, which may involve multiple stents in a single location, and may also include diagnostic cardiac catheterization and angioplasty when necessary.
1. What is CPT code 33745?
CPT code 33745 represents a medical procedure that involves the creation of a transcatheter intracardiac shunt through the placement of stents. This procedure is primarily utilized for patients with congenital cardiac anomalies, which are structural heart defects present at birth. The purpose of this intervention is to improve blood flow within the heart by establishing a pathway that allows blood to move more effectively between different chambers or vessels. The procedure is performed by an interventional cardiologist who uses imaging guidance to accurately position the catheter and stents. The code encompasses not only the shunt creation but also any necessary diagnostic cardiac catheterization and angioplasty that may be performed to facilitate the procedure.
2. Qualifying Circumstances
This CPT code can be used in specific clinical circumstances where a patient presents with congenital cardiac anomalies that require intervention to improve intracardiac flow. The use of this code is appropriate when the procedure involves the initial creation of an intracardiac shunt, which may include the placement of one or more stents. Limitations exist, as this code should not be reported for subsequent shunt placements; instead, providers should use CPT code +33746 for each additional shunt. It is important that the procedure is performed in a controlled environment with appropriate imaging guidance to ensure patient safety and procedural efficacy.
3. When To Use CPT 33745
CPT code 33745 is used when an interventional cardiologist performs the initial creation of an intracardiac shunt using stents. This code should be reported when the procedure includes imaging guidance, left and right heart diagnostic cardiac catheterization for congenital anomalies, and any target zone angioplasty that may be necessary. It is crucial to note that this code is specific to the initial shunt creation; therefore, if additional shunts are placed during the same session, the provider must report those separately using +33746. The code cannot be used in conjunction with other codes that describe similar procedures unless specified, ensuring accurate billing and documentation.
4. Official Description of CPT 33745
Official Descriptor: Transcatheter intracardiac shunt (TIS) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, including all imaging guidance by the proceduralist, when performed, left and right heart diagnostic cardiac catheterization for congenital cardiac anomalies, and target zone angioplasty, when performed (eg, atrial septum, Fontan fenestration, right ventricular outflow tract, Mustard/Senning/Warden baffles); initial intracardiac shunt.
5. Clinical Application
The clinical application of CPT code 33745 is centered around the treatment of congenital cardiac anomalies that impede normal blood flow within the heart. By creating an intracardiac shunt, healthcare providers can alleviate symptoms associated with these defects, improve oxygenation of blood, and enhance overall cardiac function. This procedure is particularly important for patients who may experience significant morbidity or mortality due to their congenital conditions. The use of stents allows for a minimally invasive approach, reducing recovery time and potential complications compared to traditional surgical methods.
5.1 Provider Responsibilities
During the procedure, the provider, typically an interventional cardiologist, undertakes several critical responsibilities. Initially, the provider ensures that the patient is appropriately prepped and anesthetized. A small incision is made to access a major vessel, often the femoral vein, through which a catheter is introduced. The provider then advances the catheter over a guidewire into the heart, utilizing imaging guidance to navigate accurately. Once in position, the provider may perform left and right heart diagnostic cardiac catheterization to assess congenital anomalies. If necessary, angioplasty is performed in the target zone to pre-dilate the area for stent placement. The provider then places one or more stents to create the intracardiac shunt, followed by potential angioplasty in the target area. Finally, the catheter is withdrawn, and the access site is closed, completing the procedure.
5.2 Unique Challenges
There are several unique challenges associated with the creation of an intracardiac shunt. One significant challenge is the need for precise navigation of the catheter through the vascular system to reach the heart, which requires a high level of skill and experience. Additionally, the presence of congenital anomalies can complicate the procedure, as variations in anatomy may necessitate adjustments in technique. The use of imaging guidance is crucial, as it allows the provider to visualize the structures of the heart and surrounding vessels in real-time. Furthermore, managing potential complications, such as bleeding or infection at the access site, is essential for ensuring patient safety and successful outcomes.
5.3 Pre-Procedure Preparations
Before the procedure, the provider must conduct thorough evaluations and preparations. This includes obtaining a detailed medical history and performing a physical examination to assess the patient’s overall health and suitability for the procedure. Diagnostic imaging studies, such as echocardiograms or cardiac MRI, may be performed to evaluate the specific congenital anomalies present. Additionally, the provider must ensure that the patient is adequately informed about the procedure, including potential risks and benefits. Pre-procedure laboratory tests may also be conducted to assess the patient’s coagulation status and overall cardiac function.
5.4 Post-Procedure Considerations
After the procedure, careful monitoring of the patient is essential to ensure stability and detect any potential complications. The access site must be assessed for signs of bleeding or infection, and the patient’s vital signs should be closely monitored. Follow-up imaging may be necessary to evaluate the success of the shunt creation and ensure that blood flow is adequate. The provider will also discuss post-procedure care with the patient, including activity restrictions and signs of complications to watch for. Ongoing follow-up appointments may be scheduled to monitor the patient’s condition and assess the need for any additional interventions.
6. Relevant Terminology
Cardiac catheterization: The insertion of a catheter (tube) into a major vessel in the groin or another location, and advanced to the heart to perform diagnostic tests, such as dye studies, and therapeutic procedures. This procedure is essential for diagnosing and treating various cardiac conditions.
7. Clinical Examples
1. A 5-year-old patient with a history of atrial septal defect undergoes a procedure to create an intracardiac shunt using stents to improve blood flow.
2. An infant diagnosed with a congenital heart defect requiring a Fontan procedure has an initial shunt created via stent placement.
3. A teenager with a Mustard procedure complication requires a new intracardiac shunt to restore proper circulation.
4. A patient with right ventricular outflow tract obstruction receives stent placement to create an effective shunt.
5. A child with complex congenital heart disease undergoes diagnostic cardiac catheterization followed by the creation of an intracardiac shunt.
6. An adult with a history of congenital heart disease requires an initial shunt creation to alleviate symptoms of heart failure.
7. A newborn with a critical congenital heart defect is treated with transcatheter shunt placement to improve oxygenation.
8. A patient with a previously placed shunt experiences complications and requires a new stent to be placed.
9. A pediatric patient with a history of cardiac anomalies undergoes a procedure to create an intracardiac shunt to enhance blood flow.
10. An interventional cardiologist performs a transcatheter shunt creation in a patient with a congenital heart defect to improve cardiac function.