Analyzing Coding for Repair of Structural Heart Defect: Transcatheter Closure of Paravalvular Leak

Coding for cardiology may contain some complex circumstances that lead to coding errors and denials.  In some outlying situations, a complication may occur following the replacement of a heart valve. Three codes (93590, 93591, and 93592) identify and allow coding for these services. By grasping a better understanding of this tricky and confusing area when it arises, cardiology CPT® coders and healthcare and regulatory compliance management and professionals can better overcome any challenges and code correctly. Let’s review the foundations of these codes for future success.

Coding Attribute Breakdown

Understand that the first correction of a paravalvular leak (PVL) is not normally significant enough to warrant a repair, but in those instances when required, these three codes allow a less invasive option as opposed to an open surgical procedure.

  • 93590 Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, mitral valve
  • 93591 Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, aortic valve
  • +93592 Percutaneous transcatheter closure of paravalvular leak; each additional occlusion device (List separately in addition to code for primary procedure)

What are the attributes of the procedure? The following factors are clear steps in this service:

  • Percutaneous access is performed.
  • Sheath is advanced.
  • Delivery system is brought to the location of the paravalvular leak.
  • Closure device is positioned and repositioned.
  • Closure device is deployed.

Procedure Definition and Assignment

Know that both codes 93590 and 93591 define the placement of initial occlusion devices fluoroscopy (76000) as well as angiography and radiological supervision and interpretation (i.e., S & I or RSI). Additionally, these codes are included in PVL procedures and should not be separately coded at the same encounter.

Separate code assignment may come into question with services like this. So, when is it unacceptable to assign separate codes? When performing the placement of the initial (mitral valve) closure device (i.e., code 93590), do not assign separate codes for:

  • left heart catheterization
  • left ventriculography
  • or a transseptal puncture (i.e., 93542, 93543, 93458, 93459, 93460, 93461, 93531–93533, 93565).

However, should a transapical left heart access be performed (CPT code +93462), it may be separately reported in addition to the PVL procedure.

If performing the placement of the initial (aortic valve) closure device (i.e., code 93591), do not assign separate codes for:

  • left heart catheterization
  • left ventriculography
  • or a transseptal puncture (i.e., 93542, 93543, 93458, 93459, 93460, 93461, 93531–93533, 93565).

Additionally, understand that code 93567 (for an aortic root angiogram) may not be assigned when submitting code 93591 but may be assigned with code 93590. Note that should a transapical left heart be performed (CPT code +93462), it may be separately reported in addition to the PVL procedure.

When addressing code 93952, it is also important to know that this code describes an add-on service and is used to identify any additional occlusion device that is placed after the primary aortic or mitral valve treatments.

Explore more insights and master understanding of CPT coding and compliance with our Peripheral & Cardiology Coder.