1. 1 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. CHAPTER 7 CARDIOVASCULAR SYSTEM

2. 2 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiovascular System CV coding may require codes from:CV coding may require codes from: RadiologyRadiology MedicineMedicine SurgerySurgery (Cont’d…)

3. 3 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiovascular System (…Cont’d) Radiology: Diagnostic studiesRadiology: Diagnostic studies Medicine: Nonsurgical and percutaneousMedicine: Nonsurgical and percutaneous Surgery: Open and percutaneousSurgery: Open and percutaneous

4. 4 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiology Coding Terminology Invasive: Enters bodyInvasive: Enters body –Example: Opening chest for removal, tumor on heart or percutaneous placement of catheter in artery Both Medicine and Surgery sections contain invasive proceduresBoth Medicine and Surgery sections contain invasive procedures (Cont’d…)

5. 5 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiology Coding Terminology (…Cont’d) Noninvasive: Procedures that do not break skinNoninvasive: Procedures that do not break skin –Example: Electrocardiogram –Example: Electrocardiogram (Cont’d…)

6. 6 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiology Coding Terminology (…Cont’d) Electrophysiology (EPS): Study of electrical system of heartElectrophysiology (EPS): Study of electrical system of heart ―Example: Study of irregular heartbeat (arrhythmia) ―Example: Study of irregular heartbeat (arrhythmia) (Cont’d…)

7. 7 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiology Coding Terminology (…Cont’d) (…Cont’d) Nuclear Cardiology: Diagnostic and treatment specialty, uses radioactive substances for cardiac conditionsNuclear Cardiology: Diagnostic and treatment specialty, uses radioactive substances for cardiac conditions Example: MRIExample: MRI

8. 8 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiovascular in Surgery Section Codes for procedures:Codes for procedures: –Heart/Pericardium (33010-33999) Pacemakers, valve disordersPacemakers, valve disorders –Arteries/Veins (34001-37799)

9. 9 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Heart/Pericardium (33010-33999) Both percutaneous and open surgicalBoth percutaneous and open surgical Extensive notes throughoutExtensive notes throughout Frequent changes with medical advancesFrequent changes with medical advances(Cont’d…)

10. 10 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Heart/Pericardium (33010-33999) (…Cont’d) Examples of Heart/Pericardium subheadings:Examples of Heart/Pericardium subheadings: –Pericardium –Cardiac Tumor –Pacemaker or Pacing Cardioverter- Defibrillator

11. 11 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Heart/Pericardium Categories Pericardiocentesis: Percutaneous withdrawal of fluid from pericardial spacePericardiocentesis: Percutaneous withdrawal of fluid from pericardial space Excision of Cardiac Tumor: Open surgical procedure for removal of tumor on heartExcision of Cardiac Tumor: Open surgical procedure for removal of tumor on heart

12. 12 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Pacemaker or Pacing Cardioverter-Defibrillator (33202-33249) Figure: 7.5 A, Single pacemaker insertion. B, Biventricular pacemaker. Devices that assist heart in electrical functionDevices that assist heart in electrical function (Cont’d…)

13. 13 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Pacemaker or Cardioverter- Defibrillator (33202-33249) (…Cont’d) Divided by where pacer placed, approach, and type of serviceDivided by where pacer placed, approach, and type of service Pacemaker electrically stimulates myocardium of one or more chambers to contract when heart fails to do soPacemaker electrically stimulates myocardium of one or more chambers to contract when heart fails to do so Device can be temporary or permanentDevice can be temporary or permanent(Cont’d…) From Forbes CD, Jackson WF: Color Atlas and Text of Clinical Medicine, ed 3, 2003, Mosby.

14. 14 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Pacemaker or Cardioverter- Defibrillator (33202-33249) (…Cont’d) Placed:Placed: –Atrium (single chamber) –Ventricle (single chamber) –Both (dual chamber) –Biventricular, both ventricles and right atrium (uses 3 leads) –Biventricular, both ventricles and right atrium (uses 3 leads) (Cont’d…) From Miller RD, editor: Miller's Anesthesia, ed 6, Philadelphia, 2005, Churchill Livingstone. dual 3

15. 15 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Pacemaker or Cardioverter- Defibrillator (33202-33249) (…Cont’d) Approach:Approach: –Epicardial: Open procedure to place on heart –Transvenous: Through vein to place in heart (Cont’d…)

16. 16 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Pacemaker or Cardioverter- Defibrillator (33202-33249) (…Cont’d) Type of ServiceType of Service –Initial placement or replacement of all or part –Number of leads placed –Number of leads placed (Cont’d…)

17. 17 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Pacemaker or Cardioverter- Defibrillator (33202-33249) (…Cont’d) Patient record indicates revision or replacementPatient record indicates revision or replacement Usual follow-up period 90 days (global period)Usual follow-up period 90 days (global period) Use -78 to indicate return to operating room within global periodUse -78 to indicate return to operating room within global period

18. 18 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Electrophysiologic Operative Procedures (33250-33266) Surgeon repairs defect causing abnormal rhythmSurgeon repairs defect causing abnormal rhythm Endoscopy ProcedureEndoscopy Procedure –Without CP Codes based on reason for procedure, approach, and if CP bypass usedCodes based on reason for procedure, approach, and if CP bypass used

19. 19 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Electrophysiologic Operative Procedures (33250-33266) Chest opened to full view—IncisionChest opened to full view—Incision –Cardiopulmunary (CP) bypass usually used

20. 20 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Patient-Activated Event Recorder (33282, 33284) Also known as cardiac event recorder or loop recorderAlso known as cardiac event recorder or loop recorder Internal surgical implantation requiredInternal surgical implantation required Divided based on device being implanted or removedDivided based on device being implanted or removed

21. 21 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiac Valves (33400-33496) Divided on valve and CP bypass:Divided on valve and CP bypass: –Aortic –Mitral –Tricuspid –Pulmonary Code descriptions all similarCode descriptions all similar

22. 22 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Coronary Artery Bypass Graft CABG performed for coronary arteries severely clogged (atherosclerosis)CABG performed for coronary arteries severely clogged (atherosclerosis)(Cont’d…) Figure: 7.6

23. 23 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Coronary Artery Bypass (…Cont’d) Determine what was used in repair:Determine what was used in repair: –Vein (33510-33516) –Artery (33533-33536) –Both artery and vein (33517-33523 and 33533-33536) (Cont’d…) From Chabner DE: The Language of Medicine, ed 8, St. Louis, 2007, Saunders.

24. 24 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Coronary Artery Bypass (…Cont’d) Number of bypass grafts performed and if vein and arterial grafts are usedNumber of bypass grafts performed and if vein and arterial grafts are used –Example: Three venous grafts

25. 25 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Venous Grafting Only for Coronary Artery Bypass Graft Codes 33510-33516Codes 33510-33516 –Divided based on number of grafts being placed Procurement of saphenous vein included in procedure (not coded separately) when retrieved through open incisionProcurement of saphenous vein included in procedure (not coded separately) when retrieved through open incision Code + 33508 reported separatelyCode + 33508 reported separately –Endoscopic, surgical, video-assisted harvest of vein(s) –Add-on code, so do not append -51

26. 26 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Arterial Grafting (33533-33536) Divided based on number of graftsDivided based on number of grafts Right coronary artery (RCA) has two branchesRight coronary artery (RCA) has two branches –Right marginal –Right posterior descending (PDA) Left main coronary artery (LMCA) has seven branchesLeft main coronary artery (LMCA) has seven branches 1) Left anterior descending, 2) diagonal, 3) septal, 4) circumflex (LCX), 5) obtuse marginal (OM), 6) posterior descending, 7) posteriolateral (Cont’d…)

27. 27 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Arterial Grafting (…Cont’d) Several codes (33542-33548) for myocardial resection, repair of a ventricular septal defect, and ventricular restoration proceduresSeveral codes (33542-33548) for myocardial resection, repair of a ventricular septal defect, and ventricular restoration procedures Obtaining artery for grafting included in codes, except:Obtaining artery for grafting included in codes, except: –Procuring an upper extremity artery (i.e., radial artery), coded separately (35600)

28. 28 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Combined Arterial-Venous Grafting Codes 33517-33523Codes 33517-33523 –Divided based on number of grafts Report combined arterial-venous procedures with two codes:Report combined arterial-venous procedures with two codes: –1) appropriate combined arterial-venous graft code, and –2) appropriate arterial graft code (33533-33536). –The -51 modifier not used with these codes (Cont’d…)

29. 29 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Combined Arterial-Venous Grafting (…Cont’d) Procuring saphenous vein included, if open retrievalProcuring saphenous vein included, if open retrieval Endoscopic harvest is reported with 33508Endoscopic harvest is reported with 33508 If reoperation report with 33530If reoperation report with 33530 –No -51, add on code Never used aloneNever used alone Add-on codes always used with Arterial Grafting codes (33533-33536)Add-on codes always used with Arterial Grafting codes (33533-33536) Arterial-Venous codes report only venous graft portion of procedureArterial-Venous codes report only venous graft portion of procedure

30. 30 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Endovascular Repair of Descending Thoracic Aorta (33880-33891) Placement prostheses for repair of descending thoracic aortaPlacement prostheses for repair of descending thoracic aorta Synthetic aortic prostheses placed via catheterSynthetic aortic prostheses placed via catheter Less invasive than chest or abdominal incisionLess invasive than chest or abdominal incision Report fluoroscopic guidance separately, 75956- 75959Report fluoroscopic guidance separately, 75956- 75959 Includes diagnostic imaging (pre- and intraoperative)Includes diagnostic imaging (pre- and intraoperative) Stent-graft (endoprosthesis) reinforces weakened areaStent-graft (endoprosthesis) reinforces weakened area

31. 31 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Arteries and Veins Subheading (34001-37799) Only for noncoronary vesselsOnly for noncoronary vessels Divided based on whether artery or vein usedDivided based on whether artery or vein used –Example: Different codes for embolectomy, depending on artery or vein Codes describe excision of acquired thrombus or congenital thrombus of an artery or veinCodes describe excision of acquired thrombus or congenital thrombus of an artery or vein Thrombus, aggregation of blood factors frequently causing vascular obstruction at the point of formationThrombus, aggregation of blood factors frequently causing vascular obstruction at the point of formation(Cont’d…)

32. 32 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Embolectomy and Thrombectomy (34001-34490) Embolus: Dislodged thrombusEmbolus: Dislodged thrombus Thrombus: Mass of material in vessel, in place of formationThrombus: Mass of material in vessel, in place of formation Balloon removal: Threaded into vessel, inflated under mass, pulled out with massBalloon removal: Threaded into vessel, inflated under mass, pulled out with mass

33. 33 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Embolectomy Removal of embolusRemoval of embolus Figure: 7.12

34. 34 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Arteries and Veins (34001-37799) (…Cont’d) Catheters placed into vessels for monitoring, removal, repairCatheters placed into vessels for monitoring, removal, repair Using nonselective or selective catheter placementUsing nonselective or selective catheter placement(Cont’d…) From Roberts JR, Hedges JR, editors: Clinical Procedures in Emergency Medicine, ed 4, Philadelphia, 2004, Saunders.

35. 35 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Arteries and Veins (34001-37799) (…Cont’d) Nonselective: Direct placement without further manipulationNonselective: Direct placement without further manipulation Selective: Place and then manipulate into further order(s)Selective: Place and then manipulate into further order(s)

36. 36 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Catheter Placement Example Nonselective: 36000, Introduction of needle into veinNonselective: 36000, Introduction of needle into vein Selective: 36012, Placement of catheter into second order venous systemSelective: 36012, Placement of catheter into second order venous system

37. 37 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Vascular Families Are Like a Tree Main branch—first order (tree trunk)Main branch—first order (tree trunk) Second order branch (tree limb)Second order branch (tree limb) Third order branch (tree branch)Third order branch (tree branch) Appendix L, CPT, Vascular FamiliesAppendix L, CPT, Vascular Families –Lists first, second, third, and beyond third order branches –Assumption that starting point is catheterization of aorta

38. 38 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Brachiocephalic Vascular Family Report farthest extent of catheter placement in a vascular familyReport farthest extent of catheter placement in a vascular family Figure: 7.11

39. 39 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Venous Reconstruction (34501-34530) Types of repair:Types of repair: –Valve of femoral vein –Vena cava –Saphenopopliteal vein anastomosis

40. 40 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Aneurysm Aneurysm: ballooned or weakened area of vesselAneurysm: ballooned or weakened area of vessel To select the correct code, check the operative report for:To select the correct code, check the operative report for: –Type of prosthesis –Location of aneurysm –Any additional services to facilitate placement of endograft –Whether open artery access was performed, and if so, was conduit created –Whether open repair was required (Cont’d…)

41. 41 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Aneurysm (…Cont’d) Repair by removal, bypass, or coil placementRepair by removal, bypass, or coil placement Coil placement: Tiny, flexible, platinum coil pushed into aneurysm and forms “ball” to obstruct blood flow into aneurysmCoil placement: Tiny, flexible, platinum coil pushed into aneurysm and forms “ball” to obstruct blood flow into aneurysm Endovascular repair (34800-34900) from inside vesselEndovascular repair (34800-34900) from inside vessel Direct (35001-35152) from outside vesselDirect (35001-35152) from outside vessel

42. 42 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. 34800-3483434800-34834 Extensive notes preceding codes—“must reading”Extensive notes preceding codes—“must reading” Uses fluoroscopic guidance report Radiology 75952 or 75953Uses fluoroscopic guidance report Radiology 75952 or 75953 Includes access, catheter manipulation, balloon angioplasty, stent placement, site closureIncludes access, catheter manipulation, balloon angioplasty, stent placement, site closure Other procedures performed at same time are coded separatelyOther procedures performed at same time are coded separately Verify bundles codes in CCI editsVerify bundles codes in CCI edits Endovascular Repair of Abdominal Aortic Aneurysm

43. 43 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Endovascular Repair of Iliac Aneurysm (34900) Extensive notes before codesExtensive notes before codes Uses fluoroscopic guidance (75954)Uses fluoroscopic guidance (75954) Includes positioning, deployment of stent or balloon angioplastyIncludes positioning, deployment of stent or balloon angioplasty Report separatelyReport separately –Open femoral or iliac artery exposure –Introduction of guide wires or catheters –Extensive artery repair or replacement

44. 44 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Repair Arteriovenous Fistula (35180-35190) Abnormal passageAbnormal passage Divided based on fistula type:Divided based on fistula type: –Congenital –Acquired/Traumatic –By site

45. 45 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Angioplasty and Atherectomy (35450-35495) Open or percutaneous by vesselOpen or percutaneous by vessel Transluminal angioplasty: Catheter passed into vessel and stretchedTransluminal angioplasty: Catheter passed into vessel and stretched –Code per vessel –Stent placement reported separately –Code imaging separately Transluminal atherectomy: Guide wire threaded into vessel and clots destroyedTransluminal atherectomy: Guide wire threaded into vessel and clots destroyed

46. 46 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Noncoronary Bypass Grafts (35500-35671) Divided by:Divided by: –Vein –In-Situ Veins (veins repaired in their original place) –Other than Vein Coded according to the beginning and ending vessels of the graft and vein used for the graftCoded according to the beginning and ending vessels of the graft and vein used for the graft

47. 47 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Bypass Graft, Vein Code by type of graft and vessels being used to bypassCode by type of graft and vessels being used to bypass –Example: 35506, Bypass graft, with vein; carotid-subclavian or subclavian-carotid –Graft attached to carotid and to subclavian, bypassing a defect of subclavian

48. 48 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Vascular Injection Procedures (36000-36522) Divided into:Divided into: –Intravenous –Intra-Arterial—Intra-Aortic –Venous (Cont’d…)

49. 49 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Vascular Injection Procedures (36000-36522) (…Cont’d) Used for many procedures, includes:Used for many procedures, includes: –Local anesthesia –Introduction of needle –Catheter –Injection of contrast material –Pre- and post-operative care Example: Injection of an opaque substance for venographyExample: Injection of an opaque substance for venography

50. 50 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Transcatheter Procedures (37184-37216) Arterial mechanical thrombectomy (37184- 37186) Removal arterial thrombus by mechanical deviceRemoval arterial thrombus by mechanical device Used to report a variety of transcatheter proceduresUsed to report a variety of transcatheter procedures Venous mechanical thrombectomy (37187, 37188) Removal venous thrombus by means of a mechanical deviceRemoval venous thrombus by means of a mechanical device

51. 51 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiovascular in Medicine Section Services can be:Services can be: –Invasive or noninvasive –Diagnostic or therapeutic –Diagnostic or therapeutic (Cont’d…)

52. 52 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiovascular in Medicine Section (…Cont’d) Subheadings:Subheadings: –Therapeutic Services and Procedures –Cardiography –Echocardiography –Echocardiography (Cont’d…)

53. 53 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. CV in Medicine Section (…Cont’d) Cardiac CatheterizationCardiac Catheterization Intracardiac Electrophysiologic (EP) Procedures/StudiesIntracardiac Electrophysiologic (EP) Procedures/Studies Peripheral Arterial Disease (PAD) RehabilitationPeripheral Arterial Disease (PAD) Rehabilitation Noninvasive Physiologic Studies and ProceduresNoninvasive Physiologic Studies and Procedures Other ProceduresOther Procedures

54. 54 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Therapeutic Services (92950-92998) Types of services:Types of services: –Cardioversion –Infusions –Thrombolysis –Catheter placement (Cont’d…)

55. 55 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Therapeutic Services (92950-92998) (…Cont’d) Many groups of codes are divided by:Many groups of codes are divided by: –Method (e.g., balloon, blade) –Location (e.g., aortic or mitral valve) –Number (e.g., single or multiple vessels)

56. 56 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiography (93000-93278) Types of service:Types of service: –Stress tests –Holter monitor From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders. From Forbes CD, Jackson WF: Color Atlas and Text of Clinical Medicine, ed 3, 2003, Mosby.

57. 57 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiography (93000-93278) ElectrocardiogramElectrocardiogram Separate codes for global procedure and components (professional and technical)Separate codes for global procedure and components (professional and technical) –See 93000, 93005, 93010

58. 58 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Holter Report Used to identify cardiac arrhythmiasUsed to identify cardiac arrhythmias Figure: 7.18

59. 59 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Echocardiography (93303-93350) Noninvasive diagnostic procedure: Ultrasound detects presence of cardiac or vascular diseaseNoninvasive diagnostic procedure: Ultrasound detects presence of cardiac or vascular disease Figure: 7.19

60. 60 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiac Catheterization (93501-93581) Used to identify valve disorders, abnormal blood flowUsed to identify valve disorders, abnormal blood flow Many bundled services in catheterization codesMany bundled services in catheterization codes (Cont’d…)

61. 61 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiac Catheterization (93501-93581) (…Cont’d) Example:Example: –Introduction –Positioning/Repositioning of catheter –Pressure readings inside heart or vessels –Blood samples –Rest/Exercise studies –Final evaluation and report Many codes -51 exemptMany codes -51 exempt

62. 62 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Three Components of Coding Cardiac Catheterization Placement of catheter (93501-93533)Placement of catheter (93501-93533) Injection (93539-93545)Injection (93539-93545) Imaging supervision, interpretation, and report (93555 or 93556)Imaging supervision, interpretation, and report (93555 or 93556) From Chabner DE: The Language of Medicine, ed 8, St. Louis, 2007, Saunders.

63. 63 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Intracoronary Brachytherapy (92974) New procedure, uses radioactive substances to destroy restenosis of coronary vesselNew procedure, uses radioactive substances to destroy restenosis of coronary vessel Patients have had stent placed in coronary vesselPatients have had stent placed in coronary vessel Stent “restenosis” (reformation of plaque)Stent “restenosis” (reformation of plaque) (Cont’d…) From Zipes DP, editor: Braunwald's Heart Disease, ed 7, Philadelphia, 2005, Saunders Brachytherapy delivery system for coronary artery stent restenosis From Zipes DP, editor: Braunwald's Heart Disease, ed 7, Philadelphia, 2005, Saunders

64. 64 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Intracoronary Brachytherapy (…Cont’d) Cardiologist: Places guide wire and catheterCardiologist: Places guide wire and catheter Radiation oncologist: Places radioactive elementsRadiation oncologist: Places radioactive elements

65. 65 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Intracardiac Electrophysiologic Procedures/Studies (93600-93662) Services to diagnose and treat conditions of electrical system of heartServices to diagnose and treat conditions of electrical system of heart Tests involve placement of special catheters into heart and cardial vessels for purpose of pacing and recording intracardiac activityTests involve placement of special catheters into heart and cardial vessels for purpose of pacing and recording intracardiac activity

66. 66 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. EP System of Heart Electrical conduction systemElectrical conduction system(Cont’d…) Figure: 7.21

67. 67 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. EP System of Heart (…Cont’d) Electrical recording codes divided based on location of recording deviceElectrical recording codes divided based on location of recording device Example: Bundle of His or right ventricleExample: Bundle of His or right ventricle(Cont’d…)

68. 68 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. EP System of Heart (…Cont’d) Pacing: Temporary pacing to stabilize beating of heartPacing: Temporary pacing to stabilize beating of heart Example: Intraventricular or intra- arterial pacingExample: Intraventricular or intra- arterial pacing

69. 69 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Peripheral Arterial Disease (PAD) Rehabilitation (93668) Rehabilitation sessions: 45-60 minutesRehabilitation sessions: 45-60 minutes Use of motorized treadmill/track to build patient’s CV enduranceUse of motorized treadmill/track to build patient’s CV endurance Supervised by exercise physiologist or nurseSupervised by exercise physiologist or nurse

70. 70 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Noninvasive Physiologic Studies and Procedures (93701-93790) Category contains codes for services such as:Category contains codes for services such as: –Plethysmography: Recordings of changes in size of body part when blood passes through it –Plethysmography: Recordings of changes in size of body part when blood passes through it (Cont’d…)

71. 71 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Noninvasive Physiologic Studies and Procedures (93701-93790) (…Cont’d) Electronic Analysis: Checks electronic function of devices, such as pacemakersElectronic Analysis: Checks electronic function of devices, such as pacemakers(Cont’d…)

72. 72 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Noninvasive Physiologic Studies and Procedures (93701-93790) (…Cont’d) Ambulatory Blood Pressure Monitoring: Outpatient basis over 24-hour periodAmbulatory Blood Pressure Monitoring: Outpatient basis over 24-hour period Thermograms: Visual recordings of temperature of bodyThermograms: Visual recordings of temperature of body From Forbes CD, Jackson WF: Color Atlas and Text of Clinical Medicine, ed 3, 2003, Mosby.

73. 73 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiovascular in Radiology Section Divided complete procedures into two components: Technical and ProfessionalDivided complete procedures into two components: Technical and Professional(Cont’d…)

74. 74 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiovascular in Radiology Section (…Cont’d) Radiology Section, Heart (75557-75564) and Aorta/Arteries (75600-75790) subsectionsRadiology Section, Heart (75557-75564) and Aorta/Arteries (75600-75790) subsections (Cont’d…)

75. 75 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiovascular in Radiology Section (…Cont’d) Example: AngiographyExample: Angiography –Technical component angiography— remains in Radiology Section –Professional component injection—moved to Surgery Section –Professional component injection—moved to Surgery Section (Cont’d…)

76. 76 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiovascular in Radiology Section (…Cont’d) Complete angiography requires radiology code and surgery codeComplete angiography requires radiology code and surgery code Reflects common practice of cardiologist’s performing injection and radiologist’s performing angiographyReflects common practice of cardiologist’s performing injection and radiologist’s performing angiography

77. 77 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Contrast Material Often radiologic procedures use contrast material to improve imageOften radiologic procedures use contrast material to improve image Many codes have contrast material bundled into serviceMany codes have contrast material bundled into service –“With contrast” or “with or without contrast” Only injected contrast qualifiesOnly injected contrast qualifies (Cont’d…)

78. 78 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Contrast Material (…Cont’d) Contrast not included in description, used in procedure; code both contrast material and injection separatelyContrast not included in description, used in procedure; code both contrast material and injection separately Physician performs procedure in hospital outpatient department; use -26 for professional component onlyPhysician performs procedure in hospital outpatient department; use -26 for professional component only

79. 79 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. A Component Coding Example Two physicians (cardiologist and radiologist from same facility) perform angiography of third order brachiocephalic artery with contrastTwo physicians (cardiologist and radiologist from same facility) perform angiography of third order brachiocephalic artery with contrast Cardiologist placing catheter (36217)— Surgery SectionCardiologist placing catheter (36217)— Surgery Section (Cont’d…)

80. 80 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. A Component Coding Example (…Cont’d) Radiologist performs angiography (75658), Radiology SectionRadiologist performs angiography (75658), Radiology Section Supply of contrast material (99070), Medicine SectionSupply of contrast material (99070), Medicine Section

81. 81 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Conclusion CHAPTER 7 CARDIOVASCULAR SYSTEM