As a follow-up to last week’s question, how do the new 2022 congenital catheterization code directives define abnormal native connections?


Abnormal native connections exist when there are alternative pathways of blood flow through the heart and great vessels. This is typically present in patients with cyanotic congenital heart defects, any variation of the single ventricle (e.g., hypoplastic right or left heart, double outlet right ventricle), unbalanced atrioventricular canal (endocardial cushion) defect, transposition of the great arteries, with or without major aortopulmonary collateral arteries (MAPCAs), total anomalous pulmonary veins, truncus arteriosus, and any lesions with heterotaxia and/or dextrocardia. Examples of right heart catheterization through abnormal pathways include accessing the pulmonary arteries via surgical shunts, accessing the pulmonary circulation from the aorta via MAPCAs, or accessing isolated pulmonary arteries through a patent ductus arteriosus. Other examples would include right heart catheterization through cavopulmonary anastomoses, Fontan conduits, atrial switch conduits (Mustard/Senning), or any variations of single ventricle anatomy/physiology. Codes 93594, 93597 would apply.


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