Summary & Overview
CPT 0613T: Transcatheter Interatrial Septal Shunt Insertion
CPT code 0613T represents the percutaneous transcatheter insertion of an interatrial septal shunt device between the left and right atria. The device is introduced via a femoral venous puncture and positioned under imaging guidance; procedures may include left and right heart catheterization and intracardiac echocardiography. This procedure is clinically significant as a minimally invasive option for creating a controlled interatrial communication in select patients, with implications for heart failure management and investigational therapies.
Key payers in the national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how the service is defined clinically, the typical sites of care, common procedural components, and the payer landscape relevant to coverage discussions. The publication outlines benchmarks and payment considerations, summarizes recent policy and coding updates affecting transcatheter structural heart interventions, and provides clinical context to help billing, coding, and policy teams align documentation and claims submission with payer expectations.
Data not available in the input: associated taxonomies, ICD-10 diagnoses, related codes, and detailed service line coding.
Billing Code Overview
CPT code 0613T describes a percutaneous transcatheter procedure in which a provider inserts an interatrial septal shunt device between the left and right atria. The device is delivered via a femoral venous puncture and advanced through a catheter into the upper chambers of the heart under imaging guidance. The procedure may include left and right heart catheterization and intracardiac echocardiography as part of device placement and confirmation.
Service type: Transcatheter interatrial septal shunt insertion
Typical site of service: Cardiac catheterization laboratory or catheterization suite (inpatient or outpatient hospital setting) or specialized cardiac procedural unit.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 65-year-old with symptomatic heart failure with preserved ejection fraction (HFpEF) who remains symptomatic despite optimized medical therapy, presenting for percutaneous interatrial septal shunt (IASD) implantation to reduce left atrial pressure and improve exertional dyspnea. The patient undergoes pre-procedure evaluation including history and physical, medication reconciliation, transthoracic and transesophageal or intracardiac echocardiography to assess atrial septal anatomy, and right heart catheterization to measure filling pressures. On the day of service, the patient arrives to a cardiac catheterization laboratory or hybrid operating room. Under conscious sedation or general anesthesia managed by anesthesia personnel, vascular access is obtained via the femoral vein. Under fluoroscopic and echocardiographic guidance, a transseptal puncture is performed and the interatrial septal shunt device is delivered across the interatrial septum and deployed. Intracardiac echocardiography and/or transesophageal imaging confirm device position and shunt patency. Left and right heart catheterizations may be performed before or after device deployment to document baseline and post-deployment hemodynamics. Vascular sheaths are removed and access site hemostasis is achieved; the patient is monitored in a recovery area or cardiac observation unit and discharged per institutional protocol or admitted for overnight monitoring when indicated for rhythm monitoring, bleeding risk, or hemodynamic instability.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when documentation supports substantially greater work than typical for the procedure. |
23 | Unusual anesthesia | Use when general anesthesia is administered for a procedure that normally does not require it. |
51 | Multiple procedures | Use when additional distinct procedures are performed in the same session. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as planned. |
53 | Discontinued procedure | Use when the procedure is started but discontinued due to extenuating circumstances. |
62 | Two surgeons | Use when two surgeons of different specialties perform distinct portions of the procedure. |
66 | Surgical team | Use when a surgical team approach is documented for complex intraoperative management. |
78 | Unplanned return to the operating/procedure room | Use when the patient returns to the OR or cath lab intra- or post-procedure for related care. |
80 | Assistant surgeon | Use when a qualified assistant surgeon performs part of the procedure. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services | Use when services are furnished by these practitioners in states where allowed. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RC0000X | Interventional Cardiology | Primary specialty performing catheter-based structural heart procedures. |
| 207RP1001X | Clinical Cardiac Electrophysiology | May participate for intracardiac imaging or transseptal techniques. |
| 207QS0014X | Cardiology (Adult Congenital) | May perform in congenital interatrial septal anatomy or specialized centers. |
| 207RH0002X | Cardiothoracic Surgery | Participates at hybrid centers or for surgical backup; may manage complications. |
| 208100000X | Anesthesiology | Provides conscious sedation or general anesthesia as required. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I50.32 | Chronic diastolic (congestive) heart failure | Left atrial decompression via IASD addresses elevated left atrial pressure in HFpEF with diastolic dysfunction. |
I50.33 | Acute on chronic diastolic heart failure | Used when chronic HFpEF patients present with acute decompensation and may be considered for device therapy evaluation. |
I50.9 | Heart failure, unspecified | Symptomatic heart failure where interatrial shunt may be considered when etiology and physiology support benefit. |
I42.0 | Dilated cardiomyopathy | In select patients with elevated left-sided filling pressures and symptoms, shunt procedures may be considered in trials or specialized care. |
I34.9 | Nonrheumatic mitral valve disorder, unspecified | Concomitant mitral valve disease influences left atrial pressures and device candidacy and planning. |
I48.91 | Unspecified atrial fibrillation | Atrial arrhythmias are common comorbidities requiring peri-procedural management and may affect hemodynamics. |
R06.02 | Shortness of breath, orthopnea | Symptom code commonly documented as indication for symptomatic interatrial shunt placement. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
93451 | Right heart catheterization (including measurement(s) of oxygen saturation and cardiac output), with or without left heart catheterization when performed; with pulmonary artery catheterization, with or without oxygen saturation studies | Performed to document baseline and post-deployment hemodynamics; often done in same session. |
93452 | Left and right heart catheterization including intraprocedural measurement(s) of cardiac output and oxygen saturation; selective coronary angiography when performed | Left and right heart catheterization may be performed adjunctively to assess coronary anatomy and pressures. |
93503 | Intracardiac echocardiography during diagnostic or therapeutic cardiac catheterization | Intracardiac echocardiography is commonly used for real-time imaging during transseptal puncture and device deployment. |
93567 | Percutaneous transcatheter closure of atrial septal defect with device (implant) | Related structural heart device implantation code; conceptually related though different anatomic intent and technique. |
99223 | Initial hospital care, typically 70 minutes or more | Representative inpatient initial evaluation code for patients admitted post-procedure for monitoring or complications. |