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CPT Coding: Cardiovascular System
Coding Cardiovascular Procedures
55
Medical
01/19/2012

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Cards

Term
What 3 sections contain codes ffor reporting cardiology services?
Definition

Surgery

Medicine

Radiology

Term
Invasive
Definition

entering the body

breaking the skin

to make a correction or from examination

 

includes percutaneous procedures

Term
Noninvasive
Definition

not breaking the skin

usually performed for diagnostic purposes

Term
EP
Definition
  • Electrophysiology
  • the study of the electrical system of the heart
  • includes the study of arrhythmias

 

Term
Nuclear cardiology 
Definition
  • a diagnostic specialty 
  • uses radioactive radiologic procedures to aid in the dx of cardiologic conditions.
Term
When reporting nuclear cardiology services....
Definition
  • HCPCS Level II codes will often also be reported
  • "A" codes report radiopharmaceuticals
  • "G" codes report the procedures and procedures combined with the supplies, radiopharmaceuticals and drugs
  • "J" codes report the drugs
  • "Q" codes report contrast agents.
Term
"A" codes
Definition
report radiopharmaceuticals
Term
"G" codes report 
Definition
the procedures and procedures combined with the supplies
Term
"J" codes report
Definition
drugs
Term
"Q" codes
Definition
report contrast agents
Term
Cardiovascular System subsection (33010-37799) of the Surgery section
Definition
contains diagnostic and therapeutic procedure codes that are divided on the basis of whether the procedure was performed on the heart/pericardium or on arteries/veins
Term

Cardiovascular System subsection (33010-37799) of the Surgery section

Heart and Pericardium subheading  (33010-33999) 

Definition

contains codes for procedures that involve the

  • repair of the heart and coronoary vessels, such as placement of pacemakers
  • repair of valve disorders
  • graft/bypass procedures.
Term

Cardiovascular System subsection (33010-37799) of the Surgery section

Arteries and Veins Subheading (34001-37799)

Definition
noncoronary vessels
Term
The first step in selecting the correct cardiovascular surgical code is
Definition

location of the procedure

coronary vs noncoronary

Term

The Surgery section, Cardiovascular System subsection,

Heart and Pericardium Subheading

(33010-33999)

Definition
contains procedures that are performed both percutaneously and through open surgical sites.
Term
Codes in the Heart and pericardium subheading are for services provided
Definition
to repair the heart, pericardiocentesis, or coronary vessels
Term
  • Pericardiocentesis codes 33010 and 33011
Definition
  • are divided based on initial or subsequent service
Term

During pericardiocentesis 33010, 33011

insertion can be performed using radiologic (ultrasound) guidance - use of which would be reported with

Definition

a separate code from the Radiology section.

 

a note follows the pericardiocentesis codes that states: (for radiological supervision and interpretation, use 76930), that is ultrasonic guidance for pericardiocentesis, imaging supervision, and interpretation.

Term
a tube pericardiostomy (33015)
Definition
a cather is left in the pericardial sac/space leading to the outside of the body to allow for continued drainage.
Term
A procedure performed to remove a tumor of the pericardium is reported using a code from the 
Definition

Pericardium category

(33010-33050)

Term
Procedure is performed to remove a tumor from the heart, you would use a code from
Definition
the category Cardiac Tumor (33120-33130)
Term
3 components of pacemaker coding
Definition
  1. where the electrode is placed (atrium, ventrical or both ventricle and atrium
  2. Whether the procedure involves initial placemennt, replacement, upgrade or repair of all components or separate components of the pacemaker
  3. The approach used to place the pacemaker (epicardial or transvenous)
Term
epicardial approach - pacemaker insertion
Definition
involves opening the chest cavity and placing a lead on the epicardial sac of the heart.
Term
Coding for epicardial approach for pacemaker insertion are divided based
Definition
on approach to the heart: thoracotomy, upper abdominal (xiphoid region) or endoscopic
Term
Transvenous approach to pacemaker insertion involves 
Definition
accessing a vein (subclavian or jugular) and inserting an electrode (lead) into the vein
Term
Reporting for transvenous approach for pacemaker insertion with flouroscopy
Definition

Fluoroscopic portion is reported separately with a radiology code (71090) because it is not bundled into the pacemaker codes.

Transvenous codes are further divided based on the area of the heart into which the pacemaker is inserted.

Term
Criteria for choosing the correct cardioverter-defibrillator codes
Definition
  1. Revision or replacement of lead(s)
  2. Replacement, repair, removal of components
  3. Approach used for insertion or repair
Term
a Change of betteries in a pacemaker or pacing cardioverter-defibrillator is a removal of the implanted generator and the reimplantation (insertion) of a new generator. Both the removal and the reimplantation are reported
Definition
separately.
Term
If electrophysiology is used to diagnose a condition that resulted in the insertion ofa pacemaker or cardioverter-defibrillator, the EP is
Definition

not included in the surgery code reported for the insertion.

The EP is reported separately using the Medicine section codes 93600-93660

Term
Radiology supervision and interpretation are (included/not included) in the pacemaker implantation codes.
Definition

not included.

if radiology supervision and interpretation are provided, you would report the service using the Radiology code 71090, Insertion of pacemaker, fluoroscopy, radiography, radiological supervision, and interpretation, remembering to use the modifier -26 on a radiology service when only the professional portion of the ervice was provided and -TC when only the technical portion was provided.

Term
the global period for pacemaker or other implantable device
Definition
90 day follow up
Term
Definition
Term
Electrophysiology codes are found where?
Definition

Most of the codes for the EP tests are in the Medicine section.

 

Term
Patient-activated event recorder is also known as a cardiac event recorder or a loop recorder. Codes are divided based on 
Definition
whether the device was implanted or removed.
Term
The category Cardiac Valves (33400-33496) has subcategory codes 
Definition
aortic, mitral, tricuspid, and pulmonary valves.
Term
The Coronary Artery Anomalies category (33500-33507) contains codes to report the services of repair of the coronary artery by various methods such as graft, ligation and reconstruction. The codes include
Definition

endarterectomy and angioplasty.

Do not unbundle

procedures  often require use of cardiopulmonary bypass to allow the surgeon to repair the defect while the heart is without blood flow 

Term

Reporting

Coronary Artery Bypass Grafting

Definition

you must know whether an artery, vein or both are being used as the bypass graft.

know how many bypass grafts are being performed.

modifier -51 would not be assigned with the code for the venous grafts because codes 33517-33523 are add-pn codes.

Term
When coding the placement of a catheter it is necessary to know 
Definition
where the catheter starts and ends.
Term
Catheter placement is
Definition
nonselective or selective
Term
Nonselective catheter placement 
Definition
means the catheter or needle is placed directly into an artery or vein (and not manipulated farther along) or is placed only into the aorta from any approach.
Term
Selective catheter placement
Definition
the catheter must be moved, manipulated, or guided into a part of the venous or arterial system other than the aorta or the vessel punctured, generally under fluoroscopic guidance.
Term

vasculor family

first order

Definition
the main artery
Term

vascular family

second order

Definition
branch off the main artery
Term

vascular family

third order

Definition
next branch off the second order
Term
Definition
Term
Cardiovascular stress test codes are used for
Definition

exercise-induced studies

pharmacologically-induced studies

Term
Ambulatory blood pressure monitoring
Definition
procedure that is done over a 240hr period by means of a portable device worn by the patient
Term
If catheterization is performed on the coronary arteries, in which section would you find the codes?
Definition
Medicine
Term
Supervision and interpretation codes for angiography are located where in the CPT manual?
Definition
Radiology section
Term
Invasive cardiology is 
Definition
entering the body to make a correction or for examination
Term
A cadriovascular stress test is an example of 
Definition
a noninvasive cardiology procedure/service
Term
The major division of the Cardiovascular subsection is whether a procedure involved a ______ vessel
Definition
coronary or noncoronary
Term
What is the name of the electrodes that are placed into the atrium and/or ventricle of the heart when a pacemaker is inserted?
Definition
leads
Term
Within the cardiovascular system, what is compared to the branches of  a tree?
Definition
vascular families
Term

Which item is not considered to be bundled in with a vascular injection?

a. local anesthesia

b. contrast media

c. introduction of needle or catheter

d. pre-injection and post-injection care related to the procedure.

Definition
b. contrast media