Chapter 17

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Chapter 17 17.1 1. Identify the 9 veins on the body figure 17.2 1. Contrast material is commonly used with ___ radiology____ procedures to enhance the image. 2. Pacing is the ___ regulation____ of the heart rate. 3. During a cardiovascular stress test, the patient is placed on a ____ treadmill______ and ECG leads are attached. 4. Within the Therapeutic services subheading, the division of the codes is based on ___ method____, ___ location____, and ____ number____. 5. A _____ cardiologist______ is an internal medicine physician who specializes in the diagnosis and treatment of conditions of the heart. 17.3 1. What are the two subheadings within the cardiovascular system subsection? Heart and ____ pericardium______, and _____ arteries and veins______. 2. The subspecialty of internal medicine that is concerned with the diagnosis and treatment of the heart is _____ Cardiology______. 3. What three sections are often used to report codes for cardiology services? Surgery section, medicine section, and radiology section 4. Procedures that break the skin for correction or examination are known as ___ invasive/ interventional_____ procedures. 5. Procedures that do not break the skin are known as ____ noninvasive____ procedures. 6. The study of the heart’s electrical system is known as _____ Electrophysiology_______. 7. The use of radioactive radiologic procedures to aid in the diagnosis of cardiologic conditions is termed ______ Nuclear cardiology_____ (two words) cardiology. 8. A catheter that is inserted into an artery and manipulated to a further order is termed _____ selective catheter_____ placement. 9. A catheter that is inserted into an artery and not manipulated to a further order is termed ____ nonselective catheter____ placement. 10. Surgical procedures in the heart and pericardium subheading contain procedures that are performed through both open surgical sites and ____ percutaneously_______. 17.4 1. Dennis Smith, a 42-year-old railroad employee (established patient), has a history of severe mitral stenosis with regurgitation, rheumatic. He is now symptomatic and his physician recommends a mitral valve replacement be performed immediately. Dennis agrees to the surgery, and the physician does a comprehensive history and physical in preparation for surgery. The physician orders a general health panel blood workup and a urinalysis (automated). On the next day, the physician performs a mitral valve replacement. Dennis recovers uneventfully and is discharged from the hospital 5 days later. CPT(2): 99215-57, 33430 ICD: I05.2

2. Thrombectomy of arterial graft. CPT: 35875 3. Direct repair of aneurysm and graft insertion for occlusive disease of the common femoral artery. CPT: 35141 4. A surgical assistant (MD) assists in performing five venous grafts in a coronary artery bypass procedure for arteriosclerosis of native arteries. CPT: 33514-80 ICD: I25.10 5. Open-heart repair of mitral valve with use of cardiopulmonary bypass. CPT: 33425 6. Removal of a single-lead implantable defibrillator pulse generator. CPT: 33233 7. Pericardiotomy for removal of clot. CPT: 33020 8. Complete repair of tetralogy of fallot is made with closure of a ventricular septal defect, and a conduit from the pulmonary artery to the right ventricle is constructed. A pulmonary graft valve is then secured. CPT: 33697 9. Shunting from subclavian to pulmonary artery using the Blalock-taussing operation for fallot’s tetralogy. CPT: 33750 ICD: Q21.3 10. Pulmonary endarterectomy with embolectomy requiring cardiopulmonary bypass. CPT: 33916 11. Direct repair of aneurysm associated with occlusion of the vertebral artery. CPT: 35005 ICD(2): I72.6, I65.09 12. Thromboendarterectomy with patch graft of iliac artery. CPT: 35351 ICD: I74.5 17.5 1. This term means entering the body: invasive 2. A cardiologist is a(n) ____ internal____ medicine physician who has chosen to specialize in the diagnosis and treatment of conditions of the heart. 3. What three sections of the CPT will you often use to code cardiology services? Surgery medicine and radiology 4. What type of cardiology enters the body -breaks the skin- to make a correction or for examination? invasive 5. What is the term that describes the study of the electrical system of the heart and includes the study of arrhythmias? Electrophysiology 6. Physician who specializes in ____ Nuclear____ cardiology uses radioactive radiologic procedures to aid in the diagnosis of cardiologic conditions. 7. Allen Jackson gets very tired walking up and down stairs. He had a hard time catching his breath and experiences instances when his heart feels as if it is beating fast. His physician has told him that he will require a pacemaker implantation. Allen goes to surgery and has a single lead pacemaker implanted with a ventricular lead. CPT: 33207 8. Five days after the pacemaker is implanted, allen feels very dizzy ad his electrocardiogram is showing some abnormalities. His physician returns him to the operating room and discovers that the pacemaker lead is malfunctioning. The pacemaker lead is replaced, and allen recovers nicely. CPT: 33216-78 9. Five years later, the battery in allen’s pacemaker is found to have become depleted. He is also having some other symptoms that his physician believes necessitate not only a replacement pacemaker, but also an upgrade to a dual-lead device. CPT: 33214

10. A new patient with a chief complaint of sharp, intermittent retrosternal pain that is reduced by sitting up or leaning forward is evaluated by a cardiologist. Chest films reveal acute pulmonary edema with acute pericardial effusion. The physician performs a pericardiocentesis. (Code the procedure and diagnoses.) CPT: 33016 ICD: J81.0, I30.0 11. Resection of an endocardium primary malignant tumor in which cardiopulmonary bypass is required. CPT: 33120 ICD: C38.0 12. Mary blacks echocardiogram and cardiac, catheterization show sever mitral stenosis with regurgitation. Her physician believes that because she is symptomatic, she should have her mitral valve replaced. The mitral valve replacement includes cardiopulmonary bypass CPT: 33430 13. Andrew Nelson has a loud heart murmur and, after study, is found to have sever aortic stenosis. He elects to have an aortic valve replacement. He is taken to the operating room and placed on a heart-lung machine. He then has his aortic valve replaced with a prosthetic valve. CPT: 33405 14. With the heart exposed through the sternum and the patient’s functions supported by a cardiopulmonary bypass, the right atrium is opened and the bigeminal arrhythmia foci are ablated by using electrical current. Bypass is discontinued and the atrium and sternum are closed in the usual fashion. CPT: 33261 ICD: I49.8 15. Insertion of permanent leadless pacemaker of the right ventricle with imaging guidance for a diagnosis of palpitations and dizziness. CPT: 33274 ICD: R00.2, R42 16. Two coronary bypass grafts using veins only CPT: 33511 17. Coronary artery bypass using two arterial grafts. CPT: 33534 18. Coronary artery bypass using three venous grafts in addition to the arterial grafts for coronary artery disease, native arteries, due to arteriosclerotic coronary heart disease. CPT: 33519 ICD: I25.10 19. Coronary artery bypass of native arteries using one internal mammary artery graft and three venous grafts. Patient has documented arteriosclerotic coronary heart disease and hypertensive heart disease, benign. CPT: 33533, 33519 ICD: I25.10, I11.9 20. Thrombectomy of the aortoiliac artery, by leg incision. CPT: 34201 21. Embolectomy, carotid artery, by neck incision. CPT: 34001 22. Thrombectomy of venous bypass graft, postop complication, initial visit. CPT: 35875 ICD: T82.867A 17.6 1. Bypass graft, with vein; carotid-subclavian. CPT: 35506 2. Bypass graft, with vein; femoral-popliteal. CPT: 35556 3. Bypass graft, using Gore-Tex; axillary-axillary. CPT: 35650 4. Excision, with application of a patch graft, for an aneurysm, common femoral artery. CPT: 35141 ICD: I72.4 5. From a right femoral artery approach, the catheter is placed in the abdominal aorta and is then threaded into the left external iliac artery where contrast material is injected and angiography is done. The surgeon then pulls back the

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catheter into the right external iliac where contrast is injected and angiography is completed. The catheter is withdrawn. The patient was diagnosed as having peripheral vascular disease. (Note : Report the catheterization and radiographic guidance services separately. ) CPT: 36246- LT, 36246-RT, 75716-26 ICD: I73.9 6. A physician provides CPR to a patient in cardiac arrest. CPT: 92950 7. Cardiovascular stress test performed in the physician’s office, using submaximal bicycle exercise with continuous ECG; physician was in attendance for supervision and provided the interpretation and report. CPT: 93015 8. Percutaneous transluminal coronary ballon angioplasty of the right coronary artery and two vessels of the left anterior descending. CPT (2): 92920-RC, 92921-LD 9. SAECG with ECG, interpretation and report only. Diagnosis of unsustained ventricular Code a selective catheter placement in the first order brachiocephalic artery (also known as the innominate artery) from the right common femoral artery access point, with ipsilateral vertebral circulation angiography, including contrast and supplies done at the clinic catheterization laboratory. tachycardia. CPT: 93278-26 ICD: I47.20 10. Right heart catheterization was performed by means of the introduction of a cardiac atheter into the venous system, with further manipulation into the right atrium, including injection into the right atrium of contrast material, multiple measurements, and sampling; image supervision was provided by the physician. CPT: 93451-26 11. Left heart catheterization of left ventricle was performed, with cutdown entry into the brachiocephalic artery, and contrast medium was injected for left ventricular angiography, including supervision, interpretation, and report. Diagnosis of coronary artery disease, native and unstable angina. CPT: 93458 ICD: I25.110 12. Indicator dilution studies when done with a cardiac catheterization are to be billed separately. T/ F 13. Bundled into the cardiac catheterization codes are the positioning and repositioning of the catheter(s). T/F 14. Modifier -51 can be added to all codes in the cardiac catheterization subheading. T/ F 15. Bundle of his recording (report professional component only) CPT: 93600-26 16. Comprehensive electrophysiologic evaluation was performed, including recording and pacing of the right atrium and right ventricle. Three electrodes were repositioned. Left ventricular recordings were also made, with pacing and induction of arrhythmia. Diagnosis of vasovagal syncope. CPT: 93620-26, 93622-26 ICD: R55 17. Code a selective catheter placement in the first order brachiocephalic artery (also known as the innominate artery) from the right common femoral artery access point, with ipsilateral vertebral circulation angiography, including contrast and supplies done at the clinic catheterization laboratory. CPT(2): 36225, 99070 18. Bilateral angiography of the arteries of the legs, with radiological supervision and interpretation (professional component only). CPT: 75716-26 19. CT scan of the heart performed for evaluation of cardiac structure and morphology, which included assessment of the cardiac function and

evaluation of the venous structures, with contrast material (professional component only). CPT: 75572-26 20. Complete cardiac MRI for morphology and function without contrast followed by contrast along with four additional sequences and stress imaging. Diagnosis of congestive heart failure and premature ventricular contractions. CPT: 75563-26 ICD: I50.9, I49.3

Chapter 17

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