Ask Dr. Z

Can we code separately for iatrogenic ASD closure when done in conjunction with MitraClip insertion (33418)? If so, do we use code 93580 or unlisted since it is an acquired defect?

"MitraClip device was prepped and advanced under the guide sheath into the LA. Proper adjustment was completed, and after several attempts the device was able to grasp both anterior and posterior leaflets of the mitral valve in a medial position. The device was closed and deployed successfully. The acquired ASD from the transseptal was felt to be large (19 mm) and noted to have significant L-R shunt. Decision was made to close the acquired ASD defect. A 37 mm Gore Cardioform ASD occluder was advanced and deployed under TEE and fluoro guidance with excellent result. No residual interatrial septal shunt."