Summary & Overview
CPT 93591: Percutaneous Aortic Valve Leak Occlusion
CPT code 93591 represents the percutaneous insertion of the first occlusion device to close a leak around the aortic valve. This structural heart intervention addresses paravalvular or transvalvular leaks around a prosthetic or native aortic valve and is increasingly relevant as transcatheter valve therapies expand. The code captures a specialized interventional cardiology procedure that typically occurs in a hospital catheterization laboratory or interventional suite and has implications for procedural coding, device coverage, and bundled payment considerations nationally.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and coding definitions, plus what to expect in payer coverage and reimbursement benchmarking. The publication outlines common claims and billing considerations tied to device-based aortic leak closure and summarizes policy developments influencing payment pathways and prior authorization practices.
This resource helps coding professionals, revenue cycle leaders, and clinical program managers understand where CPT code 93591 fits within structural heart service lines, typical sites of service, and payer engagement priorities. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 93591 describes percutaneous insertion of the first occlusion device to close a leak around the aortic valve, such as a prosthetic (artificial) valve. The procedure involves advancing a catheter through a small incision in the skin to the heart and deploying a device to occlude paravalvular or transvalvular regurgitant flow around the aortic valve.
Service Type: Interventional cardiology procedure for structural heart repair
Typical Site of Service: Hospital cardiac catheterization laboratory or interventional cardiology suite
Clinical & Coding Specifications
Clinical Context
A 78-year-old patient with a history of prior surgical aortic valve replacement presents with progressive exertional dyspnea and new heart failure symptoms. Echocardiography and transesophageal echocardiography demonstrate a clinically significant paravalvular leak around a prosthetic aortic valve with evidence of hemolysis and volume overload. The heart team (structural interventional cardiology, cardiothoracic surgery, and imaging specialists) evaluates the patient and determines the risk of repeat open surgery is high. The patient is scheduled for a percutaneous transcatheter paravalvular leak closure.
The clinical workflow includes preprocedural imaging (transthoracic and transesophageal echocardiography, CT angiography as needed), informed consent, vascular access planning (commonly femoral arterial or transapical approach), intraprocedural guidance with fluoroscopy and real-time transesophageal echocardiography, deployment of the first occlusion device to seal the leak, post-deployment assessment for residual regurgitation and hemodynamic stability, and postprocedural monitoring in a recovery or cardiac intensive care setting with follow-up imaging and anticoagulation/antiplatelet management as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no modifiers apply |